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Key2Careers College

Digital Media Registration Form

Last Name*:

First Name*:

Age

dd/ mm/ yyyy

Address:

Address (cont.):

City:

State/Province:

Country:

Postal Code:

Telephone (Home)*:

Telephone (Work)*:

Fax:

E-mail*:

Confirm E-mail*:

Alternative E-mail(If available):

Are you at least 18 years of age? Yes No

CA Citizen or Legal Permanent Residence? Yes No

PROGRAMS

Desired Program*:

Other Certificate Courses:

(Please Specify)

Start Date:

Payment Method:

Visa/Master Card/American Express

(Please see payment details below the registration form)

Cheque

Wire Transfer

PREVIOUS EDUCATION

Name of High School:

OSSD GED

Graduation Date:

Post Secondary Education

Name of College:

Dates attended:

Degree Earned:

Name of College:

Dates attended:

Degree Earned:

Name of College:

Dates attended:

Degree Earned:

Which search engine did
you use to find us?*

COMMENTS

Field(s) with * should be completed to submit the form.

Payment Details:

1. Visa/Master Card/American Express: Please call us at 1-416-926-0616

2. Cheque: Cheques should be made payable to "Key2Careers College" and mailed to us

3. Wire Transfer:

Credit to: Credit to: Key2Careers College
Account # 5205493
TD Canada Trust
1585 Mississauga Valley, Mississauga, Ontario, Canada, L5A3W9
Bank No. 004, Transit No. 03112, Swift Code: TDOMCATTTOR