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lifelong learning centre registration Form Fall 2011 LIFELONGLEARNINGCENTRE,UniversityofRegina,Regina,SKS4S0A2 Phone: 585.5816
 

Summary: 26
lifelong learning centre registration Form Fall 2011
LIFELONGLEARNINGCENTRE,UniversityofRegina,Regina,SKS4S0A2 Phone: 585.5816
Room GA 106.4, Gallery Building, College Ave & Cornwall St Fax: 585.5736
email: lifelong@uregina.ca
Name _______________________________________________________________________ Phone ________________________________
Address _____________________________________________________________________ Postal Code ___________________________
Email ________________________________________________________________________ U of R Student # _______________________
Birth date ____________________________________________________________________
(day - month - year)
o I am under 55 years o I am willing to be a class host o This is my first course at LLC if yes, how did you hear about us?
________________________________________________________________________________________________________________________
course registration fees $ __________________ All fees include GST
membership fee ($25.00) $ __________________ Apr 1, 2011 Mar 31, 2012
Parking permit ($35.18) $ __________________ Sep 1 Dec 31, 2011 License # ____________ Permit # ____________
total $ __________________ o Cash or o Cheque made payable to University of Regina
donation to llc $ __________________ (separate cheque please, or by credit or debit card receipt will be
issued for donation of $20 and over)
o DEBIT o VISA o MC o AMEX #_________________________________________________________ Exp. Date ____________
o(35050)AcrylicPainting-Beginners$115

  

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

 

Collections: Mathematics