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Lifelong Learning Centre Registration Form WINTER 2012 LIFELONG LEARNING CENTRE, University of Regina, Regina, SK S4S 0A2 Phone: 306-585-5816
 

Summary: 26
Lifelong Learning Centre Registration Form WINTER 2012
LIFELONG LEARNING CENTRE, University of Regina, Regina, SK S4S 0A2 Phone: 306-585-5816
Room GA 106 .4, Gallery Building, College Ave & Cornwall St Fax: 306-585-5736
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) $ __________________ Jan 1 Apr 6, 2012 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 DINERS CLUB o DISCOVER

  

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

 

Collections: Mathematics