Individual Course Registration

Registration Information

First Name:
Last Name:
Middle Name:
Sex:
Date of Birth: / /
Citizenship:
School Currently Attending (if any):

Contact Information

Address:
City:
Province:
Country:
Postal/Zip Code:
Home Phone: - -
Work Phone: - -
Fax Number: - -
Fax Location:
Email:

Course Details

Course Number: Course Name:
Course Number: Course Name:

Payment Details

Someone from our Continuing and Distance Education department will contact you with a total cost prior to processing your payment.

Name on Card:
Credit Card #:
Expiry Date:

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