Clinton News-Record, 1984-12-05, Page 128Application/Registrati®n Form
Please print all information
Return form to the Campus offering the course. We would
appreciate a separate cheque for each course.
CONTINUING EDUCATION - APPLICATION/REGISTRATION FORM
4
Campus:
NOTE: THIS IS NOT A RECEIPT.
Course* Day: Starts*
Specify your choice of time slot if
more than one class is advertised on
'the same day
Sex: Male ❑
Name:
- Female D
Last Name: First Name
Address:
Apt. No. No. and Street
• Postal Residence
City: Code: Telephone'
Business
Employer: Telephone'
Are you currently registered through the Registrar's Office in a full-time day Program at Conestoga College?
Yes No .
If YES to above, please enter your Student LD. #
Please check one of the following: .
(a) I am under 19 and have successfully completed Grade 12 H or,
(b) I an under 19 and have not successfully completed Grade 12 C] or,
(c) I, am a Senior Citizen (Age 60 and over) LJ or,
(d) I am over 19, but not a senior. citizen
How- Did You Find Out About Conestoga College Continuing Education Courses:
Radio Friend
Newspaper Other
Catalogue •
(Please specify)
II
ii Cheque or Money ,
Order enclosed for $ (full course fee) payable to Conestoga College.
We do not accept post-dated cheques.
f Registration is limited to Canadian Citizens and/or Permanent Residents unless• special permission has been granted by Employment and Immigration
Canada. You may apply for a refund before the start of the third scheduled class. For additional information please refer to the Refund section in .the front
of•the catalogue. We do not accept registrations or reserve spaces over the telephone It is the responsibility of each student to be enrolled in a Heaiti;•
Insurance Plan or OHIP
Applicant's Signature:
CAMPUSES
Cambridge Campus
1305 Bishop Street N.
Cambridge, Ontario.
N1R 6Z2
(519) 623-4898
Doon Campus
299 Doon Valley Dr.
Kitchener, Ontario.
N2G 4M4
(51 9) 653-7460
Date'
Note: Applications must be signed and dated. Form 8084
Clinton Campus
Vanastra Rd.
P.O. Box 160
Clinton, Ontario.
NOM 1L0
(519) 482-3458
Stratford Campus
270 Water Street
P.O. Box 848
Stratford, Ontario.
N5A 6W3
.(519) 271-5700
Immo MO
Guelph Campus
460 Speedvale Ave. W.
Guelph, Ontario.
N1H 6N6
(519) 824-9390
Waterloo Campus
435 King Street N.
Waterloo, Ontario.
N2J 2Z5
(519) 885-0300
It there Is a rn5I inlerruption please take your Appin.al,nn Registration Form to the campus otiering the course
REGISTER EARLY! DON'T BE DISAPPOINTED! CLASS SIZES ARE LIMITED!