Extension Programs Registration Form
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LastName:
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First Name:
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Address1:
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Address2:
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City:
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State/Province:
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Country:
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Zip / Postal Code:
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Home Phone:
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Work Phone:
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Fax Number:
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E-Mail Address:
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| Please click on the drop down menu to make a selection |
Program:
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Select Course Registering For:
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Method of Payment:*
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Amount in Dollars:
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Visa Number:
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Expiry Date: (mm/yyyy)
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| * Personal Cheques will take 10 business days to clear |
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Note:
If you are paying by VISA card, please call our Toll Free Number: 1-877-978-9088 or Fax your VISA card information (Fullname and Expiry Date as they appear on the card) to: 1-306-933-9362. Thanks. |