Text Box: Registration Form - Organic Inspection Training

(Please Print Clearly)
Text Box: Student Number (If you have previously attended Assiniboine Community College) Social Insurance Number: Mr. Mrs. Last Name First Name Initial Miss Ms. Mailing Address City/Town Province Postal Code Home Phone Business Phone Fax Email

Method of Payment

 

         Debit Card                         Cheque / Money Order                 Cash

        

           Visa                                     MasterCard

 

Card Number:   

 

Expiry Date:      

 

Name of Card Holder (print): 

 

Signature: 

Course Name                                           Code                    Location                           Course Dates                       Check                      Fee