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Registration Form
*
Surname
*
First or Given Names
*
Company/Organization
Title
*
Email
Email me about upcoming programs and events
Home Phone Number
Work Phone Number
*
Mailing Address
*
City
*
Province
*
Postal/Zip Code
Will you be taking advantage of the group discount?
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Yes
No
Three or more registrations must be received from the same company to be eligible. Seperate registration forms are required for each person.
Names of other persons registering:
Name 1
Name 2
Name 3
Name 4
Course Registration
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Entire Certificate
Individual Course/Module
Certificate Name
Date
*
Course Name
*
Course Date
*
Fee
1.
$
2.
$
3.
$
4.
$
Campus Parking
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Yes, I'd like to request an Acadia Parking Pass
No, I do not require parking on campus
Dates
Total ($3 per day, includes HST)
$
Payment
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Online Credit Card Payment
Cheque
Invoice my Company
Company Information
Attention
Email
Phone
Invoice/Receipt Address
City
Province
Postal/Zip Code
Cheques are payable to Acadia University.
For online credit card payments please click Credit Card Information to securely submit your credit card payment online.
PD Menu
Programs
Policies
Register
Contact PD
pd@acadiau.ca
1-800-565-6568
(902) 585-1434
fax: 902-585-1068
