Registration Form | Lakeland College

Surname:*
First Name:*
Middle Name:
Previous name (if applicable):
Birthdate (yyyy/mmm/dd eg. 1980/Jan/10):*
*
Elk Island Public School (EIPS) ID# (if applicable):
Have you attended Lakeland College or the Emergency Training Centre before?*
Street/Avenue/Box:*
Town/City:City*
Province:*
Postal Code: (no spaces)*
Country:
Email Address:*
Home Telephone Number: (xxx-xxx-xxxx)*
Business Telephone Number:
Cell Phone Number:
Course 1 #:*
Course 1 Title:*
Course 1 Class Start Date:
Course 1 Location:
Course 1 Fee: (x,xxx or xxxx)
Method of Payment:*
Card Number (please enter number without spaces):
Expiry Date (mm/yy):
Card Holder's Name:
Course 2 #:
Course 2 Title:
Course 2 Class Start Date:
Course 2 Location:
Course 2 Fee: (x,xxx or xxxx)
*

Personal Information

Surname:*

First Name:*

Middle Name:

Previous name (if applicable):

Birthdate (yyyy/mmm/dd eg. 1980/Jan/10):*

MaleFemale*

Elk Island Public School (EIPS) ID# (if applicable):

Have you attended Lakeland College or the Emergency Training Centre before?*
YesNo

Permanent Address

Street/Avenue/Box:*

Town/City:City*

Province:*

Postal Code: (no spaces)*

Country:

Email Address:*

Home Telephone Number: (xxx-xxx-xxxx)*

Business Telephone Number:

Cell Phone Number:

Course Information

Course 1 #:*

Course 1 Title:*

Course 1 Class Start Date:

Course 1 Location:

Course 1 Fee: (x,xxx or xxxx)

Course 2 #:

Course 2 Title:

Course 2 Class Start Date:

Course 2 Location:

Course 2 Fee: (x,xxx or xxxx)

Financial Information

Method of Payment:*

Via Post*VISAMasterCard

Card Number (please enter number without spaces):

Expiry Date (mm/yy):

Card Holder's Name:

*You will not be registered until your payment is received

Freedom of Information/Protection of Privacy: Lakeland College complies with the Freedom of Information and Protection of Privacy Act of Alberta. Information collected on this application form is used in the normal course of College operations in accordance with this legislation. For details on how this information is used, please refer to the Lakeland College calendar.
Declaration of Registrant: I certify that all statements made in connection with this registration are true and complete in all respects. I agree to abide by the rules and regulations as set out by the Board of Governors of Lakeland College. *

Please note: 1. You are not officially registered until full payment is received by Lakeland College before the course start date. 2. If applicable, text books and other resources are available through the Lakeland College bookstore. Call 1 800 661 6490 ext.8525. Costs are listed with course information.

**You will receive an e-mail if your registration was successful.

Academic Upgrading

Agricultural Sciences

Business

Continuing Education

Course Outlines (ICODev)

Pesticide Applicator & Commercial Dispenser

Environmental Sciences

Fire & Emergency Services

Health & Wellness

Human Services

Interior Design

Tourism

Trades & Technology Apprenticeship

Trades & Technology

University Transfer

Continuing Education

Lakeland College Continuing Education Registration Form