5 Ways to Register CALL 604.323.5322 Register using VISA or MasterCard. Receipts will be mailed.
ONLINE Register online using VISA or MasterCard. Receipts will be mailed. www.langara.ca/cs
IN PERSON Continuing Studies Office, Langara College. Pay by cheque, debit, cash or credit card.
FA X 604.323.5899 Use registration form below. Payment by credit card only.
MAIL Fill in the registration form below and mail with cheque or credit card information. Make cheques payable to Langara College.
Fax or Mail-in Registration Form Fax registration to 604.323.5899
Mail or drop off registration to:
• For VISA or MasterCard use only
Langara College Continuing Studies 100 West 49th Ave., Vancouver BC V5Y 2Z6 Phone: 604.323.5322
• Please type or print in black ink • One student may register on this form • Photocopy form for additional students
_________________________________________________________________________ Langara Student ID
METHOD OF PAYMENT
_________________________________________________________________________
Cheque
Money Order
Credit Card (circle one)
Name
_______/_______/__________
Male
Female (for statistical purposes only)
Birthdate - mm/dd/yyyy
_________________________________________________________________________
_______________________________________________ Name on Card
_______________________________________________ Credit Card Account Number
Address
_______/_______ _________________________________________________________________________ City
Province
Postal Code
_________________________________________________________________________ Home Phone
Business Phone
Local
Expiry Date
_______________________________________________ Signature
_______________________________________________ Date
________________________________________________________________________ Email
________________________________________
________________________________________
________________________________________
Course Name
Course Name
Course Name
________________________________________
________________________________________
________________________________________
Course Registration
Course Registration
Course Registration
Start Date and Time
Start Date and Time
Start Date and Time
Number (ex.78018)
Number (ex.78018)
Number (ex.78018)
________________________________________
________________________________________
________________________________________
Fee
Fee
Fee
The information on this form is collected under the authority of the Freedom of Information/Protection of Privacy Act, and is needed to process your application for admission. If you have any questions about the collection or use of the information, contact the Dean of Continuing Studies at 604.323.5642. To protect our students’ privacy, credit card data is purged upon registration.