Introduction to GIS for Public Health
website: www.GISpublichealth.com
Registration Form
Open Learning ID# (if a previous student): _______________________________
Name: ___________________________________________________________
Address to receive information: □ Home
□
Business
Street: ________________________________________________________________
City:
________________________________________________________________
Province: __________________
Postal Code: ________________________
Business telephone __________________ Fax _______________________
Home telephone ___________________________
Email: ________________________________________________________________
(Course confirmation will be sent by email)
Alumni Discount Code ___________________
Please Note: University of Guelph and University of Guelph-Humber alumni students are entitled to a 20%
discount when registering for Continuing Education (CE) non-degree courses offered through Open Learning
and Educational Support, University of Guelph. The Alumni Code is updated each year and is required at the
time of registration to obtain the discount. You may obtain the current code at
http://www.alumni.uoguelph.ca/services/services_benefits_start.shtml or call Alumni House at 519-8244120 ext. 56934.
Please register me in:
Course will begin on Monday, February 9, 2015 and conclude on Sunday, April 5, 2015.
The Regular tuition fee is $796.00 + HST $103.48.
 Introduction to GIS for Public Health
 I have previous formal training in a public health field or related experience (this is a
prerequisite to enrolling in the course)
Updated June 17, 2014
Page 1
Course Fees
Regular tuition Fee - $796.00
13% HST - $103.48
Total
$ ___________
S ___________
$ ____________
Payment
Payment must accompany the registration form. Post-dated cheques are not accepted.
□
Cheque / money order (payable to the University of Guelph)
□
Visa
□
MasterCard
Card#: ___________________________Expiry Date: ___________ 3-Digit Security Code: _____
Cardholder’s name (please print): _________________________________________
Authorizing signature: ___________________________________________________
Please send this completed Registration Form to:
Open Learning and Educational Support,
University of Guelph,
160 Johnston Hall,
Guelph, ON N1G 2W1
Phone: 519-767-5000  Fax: 519-767-1114  Email: info@OpenEd.uoguelph.ca
Refund Policy:
A full refund will be issued provided Open Learning and Educational Support receives a completed Drop
Form at least 21 calendar days prior to the course start date.
A refund, less a $75.00 administration fee will be issued provided Open Learning and Educational Support
receives a completed Drop Form at least 7 calendar days prior to the course start date.
A refund, less a $100 administration fee, will be issued provided Open Learning and Educational Support
receives a completed Drop Form 48 hours following the first day of class ( start date and time).
Failure to take part in a course does not constitute notification of withdrawal and will result in forfeiture
of the entire course fee.
Should you decide not to continue after the course drop date, you must still send in a completed drop
form prior to the last day of class to avoid academic penalty (receiving a grade of “F” on your academic
record).
Bursary: Staff and friends of the University have established and contribute annually to bursary funds
to assist students in need. We invite you to consider making a donation to one of these funds by adding
your donation amount on the registration form. Visit the website for further information about the
bursaries.
Protecting your Privacy: We are committed to protecting your privacy. The personal information
collected on this form will be used for registration purposes, for creating learner profiles, and for sending
you relevant Open Learning information we believe may be of interest to you. For further information or
Updated June 17, 2014
Page 2
to find out how to opt out of receiving future Open Learning information, call us at 519-767-5000 or visit
the Open Learning and Educational Support Privacy Policy.
Updated June 17, 2014
Page 3