AGA Registration Form
Regular Program (2011/2012)
Name
Complete Mailing Address
Email
Phone Number
Type of class: In person Distant learning Either
Level: Beginner Intermediate 1 Intermediate 2 Advanced Advanced Plus 1 Advanced Plus 2
If beginner, have you studied Gaelic before? Yes No
Do you have High Speed Internet? Yes No
What is your first class time choice? Monday Tuesday Wednesday Thursday Friday Saturday 9:00 AM 10:00 AM 11:00 AM 12:00 AM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM 7:00 PM 8:00 PM 9:00 PM
What is your second class time choice? Monday Tuesday Wednesday Thursday Friday Saturday 9:00 AM 10:00 AM 11:00 AM 12:00 AM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM 7:00 PM 8:00 PM 9:00 PM
Other times available and other comments:
(The following sections must be completed or the form will not be processed.)
Tuition Fees ($)
Beginner Intermediate 1 Intermediate 2 Advanced Advanced Plus 1 Advanced Plus 2
Full Payment with registration 395 410 425 445 465 485
Or pay by Instalments: Yes Yes Yes Yes Yes Yes
Due with Registration 170 175 180 190 200 205
Second instalment Nov30,2011 140 150 155 160 170 180
Third instalment Feb28,2012 110 110 115 120 120 125
Total 420 435 450 470 490 510
(Currency-Canadian Dollars.) (gst/hst extra were applicable.) (Students are responsible for any textbooks and computer equipment required.)
Payment Methods
Method of payment: Credit Card or Cheque or Money Order* (Registration will not be processed until payment received.)
Credit card information:
Name as appears on card:
Credit Card: VISA MasterCard AMEX
Card number (no spaces):
Expiration date: Month 1 2 3 4 5 6 7 8 9 10 11 12 Year 2011 2012 2013 2014 2015 2016 2017
If paying by cheque or money order and by instalments, a current dated cheque or money order for the 1st instalment is required along with two post-dated cheques for the 2nd and 3rd instalments.
Refunds are only available before course materials are sent to students in September.
Submit form. You will receive an acknowledgement indicating receipt of your form. If you do not receive an acknowledgement within twenty-four (24) hours, re-submit the form, Email info@gaelicacademy.ca, or call 902-453-1503.
If you prefer you can submit this form and then call in your credit card information to 902-453-1503; or you can complete and print the form and fax it to the AGA at fax: 506-450-7153. Completed forms and/or payments can also be mailed to: Atlantic Gaelic Academy, P.O. Box 86, 231 Regent St. Suite 301, Fredericton, N.B. E3B4Y2.