Yamnuska Mountain Adventures
Canada
New Zealand Semester
Course Application Form
To register please download,
complete, then fax (+1 403 678 4450) or mail to Yamnuska along with deposit or call
Yamnuska at +1 403 678 4164 or 1 866 678 4164 (N. America only) to register by phone.
Name:
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Semester Date:
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Address:--------------------------------------------------------------------------------------
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Phone: home ( )
work ( )
fax ( )
Email:
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Age: -------- Sex: --------
Occupation: ---------------------------------------
How did you hear about this program?----------------------------------------
Cancellation Coverage: (tick one)
p I do require p
I do not require
Conditions of Registration
I accept
the conditions stated below
p (please tick )
Payment, please accept my: (tick one)
p
Deposit p Payment in full
We prefer payment by cheque or bank
draft. A discount of $50 will be applied to the last payment when all
payments are by cheque or bank draft.
Contact us for
our banking information.
p Cheque/money order
enclosed p Pay by
credit card: p Visa p MC
Name on Credit Card
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Credit Card Number: ----------------------------------- Expiry Date:---------
p Please use this credit card
for 2nd & 3rd payment when due.
Signature Of Cardholder
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