Create CLLL CCRS Registration Form | University of Prince Edward Island

Name:

Registration Form

Please submit this application online, or print pdf format application and forward it to:
Certificate Program in Conflict Resolution Studies
Centre for Life-Long Learning
550 University Ave
Charlottetown, PE, C1A 4P3 Canada
902-566-0336 or 1-877- 440-2277 (CCRS) FAX - 902-566-0451

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** Reminder: Three or more participants in a given course from the same organization = 10% discount

Course: *

Course Date: *

Last Name: *

First Name: *

Address: *

City / Town: *

Province / State: *

Postal Code / Zip Code: *

Home Telephone: *

Alternate (cell, business, other):

Fax:

Email: *

Employer (if applicable):

Job Title (if applicable):

UPEI Student ID# (If you have taken a course at UPEI):

Date Of Birth: *

Include my contact information provided to other learners of this class: *

Yes

The CCRS respects your privacy. We would like to provide you the opportunity to connect with your fellow learners by having your professional contact information listed on a class contact list and a copy provided to each learner with the course materials. If you wish to be included in this list, please click the box giving us permission to do so.

Keep you up to date

The CCRS would like to keep you updated on the latest news, events and courses at the Centre. Would you like to be included on our mailing list?:

N/A

Course Update (Monthly)

News and Events (Quarterly)

* Your privacy is important to us. See our privacy policy at: UPEI Personal Information & Privacy Policy

Please click to see Cancellation Policy

Please confirm that you have read and agree to the Cancellation Policy:

Yes

Payment Options: Full course registration payment is due in advance to complete the registration process. We accept VISA, Master Card, cash, cheque, or can invoice your employer if you provide the person's name, title, and address. Please forward all payment inquires to the UPEI Accounting Department at 902-566-0316 or jlallen@upei.ca

NOTE: Please click the "SAVE" button below to submit your completed registration form to our registration coordinator.

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UNIVERSITY OF PRINCE EDWARD ISLAND

CLLL CCRS Registration Form

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