AGA Registration Form

Regular Program (2010/2011)

Name

Complete Mailing Address

Email

Phone Number

Type of class: In person Distant learning Either

Level: Beginner Intermediate I Intermediate II Advanced    Fluent

If beginner, have you studied Gaelic before? Yes No

Do you have High Speed Internet? Yes No

What is your first class time choice?

What is your second class time choice?

Other times available and other comments:

(The following sections must be completed or the form will not be processed.)

Tuition Fees

                                                               Beginner      Intermediate I     Intermediate II     Advanced         Fluent

Payment due with registration                  385          400                415              435              455

Or pay by Instalments:                            Yes          Yes                Yes              Yes              Yes

Due with Registration                                   160               170                     175                   185                    190

Second instalment due Nov 30, 2010           135               140                     145                   150                    160

Third instalment due Feb 28, 2011               110               110                     115                   120                    125

Total                                                            405               420                     435                   455                    475

(Currency-Canadian Dollars.) (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 Year

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 classes are assigned and course materials sent to students. 

Submit form. You will receive an acknowledgement indicating receipt of your form. If you don’t 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.