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?

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 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 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 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.