Summary: REGISTRATION FORM
Group: SEMESTER USER ID NUMBER
Y E A R Fall (Sept. - Dec.)
­ ­
Y E A R Winter (Jan. - Apr.)
Y E A R Spring/Summer (May - Aug.)
STUDENT INFORMATION
Last or family name First name Middle initial Home phone
( )
Cell phone
( )
Current mailing address ­ Apartment #, Street, Box # Business phone
( )
Fax Home Work
( )
City or Town Province Postal Code E-mail
Check here if this is
address change
Effective date:
DD - MON ­ YEAR

Source: Argerami, Martin - Department of Mathematics and Statistics, University of Regina

Collections: Mathematics