Registration Form
For the course ITC15 Conceptual Data Modeling

Information Technology Centre, 440 Windsor Street, Room 315

University of New Brunswick, Fredericton, N.B.

Wednesday, September 3, 2003

Course registration and payment must be received by August 29. Course enrollment is limited to 40 students. Free parking is available in the car park beside the Information Technology Building. Please fill in the following form and return it with payment (see below) to:
 

Information Technology Centre ITC 15
Faculty of Computer Science, University of New Brunswick
P.O. Box 4400, Fredericton, N.B. E3B 5A3
Phone: (506) 447-3220 FAX: (506) 453-3566 E-mail: fcs@unb.ca


Name: ________________________________________________________________________

Title: __________________________________________________________________________

Affiliation: ______________________________________________________________________

Address: _______________________________________________________________________

_______________________________________________________________________________


Telephone number: __________________________ FAX number: __________________________

E-mail address: ________________________________________

Registration fee: $375.00 ($326.09 + $48.91 HST)
 

Registration includes morning coffee, refreshment breaks, lunch at the course location, and a set of course notes. A computer projection system is used for delivering course material.
 

Method of payment (check one):
[   ]Cheque   [   ]Money Order   [   ]Purchase Order (If paying by purchase order please give PO Number) ___________________

or

Credit Card: [   ]VISA   [   ]MasterCard


Card Number: _________________________________________________

Name of Card Holder: ____________________________

Expiration date: _______________________ (please print or type)

Your Signature: _________________________________

Date signed: ______________________ (required for credit card payment only)

Please register my CEUs with EIC   [   ]
Technical Society/Prof. Eng. Association:_______________________
Membership No.__________________________

Cheque or money order remitted in Canadian dollars is to be made payable to the "UNB Information Technology Centre". Minimum course registration of seven students required.