CONTENTS JOIN US AT ACAD HOW TO REGISTER
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<strong>ACAD</strong> CONTINUING EDUC<strong>AT</strong>ION REGISTR<strong>AT</strong>ION FORM<br />
Early registration gives you the best options!<br />
Please complete this registration form for your mail-in or fax (403-284-7603). Remember to include your payment!<br />
Last Name First Name Initial<br />
<strong>ACAD</strong> Student ID # Date of birth (DD/MM/YYYY) Gender (M/F)<br />
Street address<br />
City Province Postal code<br />
Telephone (home) Telephone (work) Cell<br />
E-mail address<br />
Fax<br />
Course name<br />
crn Course date Fee<br />
1)<br />
2)<br />
3)<br />
Course fee <strong>TO</strong>TAL:<br />
5% GST (when noted in the calendar)<br />
<strong>TO</strong>TAL PAYMENT SUBMITTED<br />
- required at time of registration<br />
America Express/Visa/Mastercard number<br />
Expiry date<br />
Cardholder’s name<br />
Student signature<br />
Freedom of Information and Protection of Privacy Information you provide when you register with <strong>ACAD</strong> Extended Studies is collected under the authority of the<br />
Post-Secondary Learning Act and Freedom of Information and Protection of Privacy Act in the Province of Alberta, Section 33 (c). Your personal information is protected and can<br />
be reviewed upon request. Please contact extendedstudies@acad.ca.
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