The University of Western Ontario
Continuing Studies at Western

PREPARATORY WEEK IN TROIS-PISTOLES

Please TYPE your information. PRINT and MAIL with $425 payment to the Trois-Pistoles French Immersion School,

Western Student Services Rm 3100L, London ON N6A 3K7.

A separate payment is required for the Preparatory Week.

 

SESSION:

 

SURNAME: FIRST NAME: SEX:

DATE OF BIRTH:

ADDRESS:

CITY: PROVINCE/STATE: POSTAL CODE:

TELEPHONE: EMAIL:

 

METHOD OF PAYMENT:

CREDIT CARD NUMBER: EXPIRY:

NAME OF CARDHOLDER: DATE:

 

The personal information provided to the University is collected under the authority of the University of Western Ontario Act, 1982, as amended, and is used to administer the program, identify applicants, confirm applicant eligibility, assess status, register students, assess fees, and process payment.  The information is also used for statistical and marketing purposes, customer recognition initiatives, and to determine future programming.  Please direct questions about this collection and use of personal information to the Director, Continuing Studies, The University of Western Ontario, 240-355 Wellington Street, London, ON, N6A 3N7, tel: 519-661-2111 ext. 84909.