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(please make photocopies if applying to more than one course)
PERSONAL INFORMATION
First Name: _________________________ Last Name: _________________________ Mailing Addr: ________________________ City: __________________________ Province / State:________________ Postal Code: _____________ Country: _________________________ Home Phone: (___)________________ Home Fax :(___)__________________ |
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Company:_______________________________ Address:________________________________ City: ______________________ Province / State:_____________ Country:________________________ Postal Code:____________ Title/Position:___________________________ Business Phone: (___)__________________ Business Fax: (___)__________________ Email:_______________________________ |
| COURSE(s) - (check one or more...) | |||||||||||||||||||
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BACKGROUND INFORMATION
Current Education Level:
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Less than High School | |
High School | |
University or College |
Please select the category which best describes you:
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Pleasure Rider | |
Farm, Ranch or Stable employee | |
Breeder | |
Competitor | |
Owner | |
Other_____________________ |
How many years in the industry?_____
How did you learn about the equine certificate? _________________________________________
PAYMENT INFORMATION:
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Please include the required textbook(s) with my course package. My payment includes the cost of the textbook(s) or I authorize you to charge the cost to my credit card. |
| Tuition $ __________ Equine Guelph Donation $ __________ OOL Bursary Donation $ __________ Total Enclosed: $ __________ |
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Cheque/Money Order *(Payable to the University of Guelph) |
Card #_____________________________ |
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Visa | Cardholder: ____________________________ |
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Master Card | Expiry: _____ /_____ |
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American Express | Signature: _____________________________ |
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| Protecting Your Privacy:
We are committed to protecting your privacy. The personal information collected on this form will be used for registration purposes, for creating learner profiles, and for sending you relevant Open Learning information we believe may be of interest to you. For further information or to find out how to opt out of receiving future Open Learning information, call us at 519-767-5000 or visit: www.open.uoguelph.ca/privacy |