Non-Credit Student Registration
Please provide, if applicable, your Georgian College student identification number used
at your last registration. This will enable us to consolidate your student academic record.
Please fax your registration form to 1-705-722-1524.
YOU MUST ENTER YOUR NAME EXACTLY AS IT APPEARS ON YOUR DRIVERS LICENCE
Last Name
Mr/Mrs/Ms/Miss
Given Name (s)
Apt./Uni t
Home Address:
City or Town
Area Code
Province
Home Telephone
Month
_
Email Address
_
_
Date of Birth
Year
Postal Cod e
Day
Please include your Drivers Licence Number:
Method of payment:
Visa
MasterCard
Amex
*Debit credit cards are NOT accepted
Name of Card Holder
Credit Card #
STATUS IN CANADA (Please check off one of the boxes listed below)
CANADIAN CITIZEN
PERMANENT RESIDENT (LANDED IMMIGRANT)
Expiry Date
Signature
STUDY PERMIT
VISITOR PERMIT
*
NOTE: For COMPANY BILLING - Authorized Signature & Title are required for
processing
*
WORK PERMIT
Date:
FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT
The personal informa�on on this form is collected under the legal authority of the Colleges & Universi�es Act, R.S.O. 1990, Reg. 770. The informa�on is used for the
administra�ve and sta�s�cal purposes of the College and/or the ministries or agencies of the Government of Ontario and the Government of Canada. Student
informa�on and grades will be communicated to the Ontario Motor Vehicle Industry Council (OMVIC), and some informa�on will also be used by the College solely
for educa�onal follow-up and updates. For further informa�on please contact The Automo�ve Business School of Canada, Room H130, Georgian College, One Georgian
Dr., Barrie, Ontario L4M 3X9. Phone:(705) 722-1513, Toll Free: 1-877-722-1513.
Date:
Signature:
Subjec t
OMVI 0003
MVDA 2002 Key Elements............................................... $263
OMVI 0004
Automo�ve Record Keeping ........................................... $263
OMVI 0005OMVI
Automotive Sales Language Preparedness ......................$263Automo�ve
The tuition fee is subject to the refund policies of Georgian College
2015\OMVIC\OMVI NON CREDIT Reg Form