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UNIVERSITY OF PRINCE EDWARD ISLAND

CLLL Course Registration

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Course Application Form

* Required field

Name of Course: *

Course Date: *

Title:

Last Name: *

First Name : *

Organization:

Street Address / Box #: *

City / Town: *

Province / State: *

Postal Code / Zip Code: *

Phone (Include area code): *

Email: *

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

Date of Birth: *

(This is needed for UPEI Accounting Office purposes only)

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

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