Taber Adult Learning Registration Form

FAX
(403) 223-3412

ADDRESS
BOX 20
Provincial Building
Taber, Alberta
T1G 1V9


PERSONAL INFORMATION

Name _________________________________________
Address _______________________________________
Email _______________________________________
City ___________________________________________
Postal Code ____________________________________
Phone _________________________________________

PAYMENT OPTIONS

Paid By (Check One):
Cash Cheque Money Order Visa MasterCard
Cardholder's Name ______________________________
Card No. ______________________________________
Expiry Date ____________________________________

COURSES REGISTERING FOR:

1. Course Title ______________________________ Location ____________________ Fee $_______
2. Course Title ______________________________ Location ____________________ Fee $_______
3. Course Title ______________________________ Location ____________________ Fee $_______
4. Course Title ______________________________ Location ____________________ Fee $_______