Course Registration Form

306 307 4340 ( Breanne Konrad)

bequineservices@outlook.com

www.bequine.ca
Student Registration Form

Fill out the form carefully for registration
Student Name

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Mailing Address ( First Aid Manual will be sent to this address)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student E-mail
example@example.com
Phone Number
Company
Courses
Additional Comments/ How did you find this course?
Course Fee sent: Etransfer (bequineservices@outlook.com)

Etransfer Equi-Health Emergency First Aid-Online 79.5+gst = (83.48$ Non Refundable) Etransfer Equi- Health Emergency First Aid- In Person- 159+gst= (166.95$ Non refundable) Etransfer Canine First Aid Fundamentals -Online 79+gst = (82.95$ Non Refundable) Etransfer Canine Emergency First Aid Full Day - In Class 149 +gst= (156.45)$ Non Refundable
Invoice to be paid upon receipt & clinic registrations will close 10 business days out to allow for shipment of manuals for participants out of the local area. Etransfers accepted at bequineservices@outlook.com.

Payment will be refunded if class becomes cancelled. If the student has already received their First Aid manuals, payment less the manual fee will be returned.
I agree to terms & conditions. Payment due before manuals are provided. Registration fee is transferable but non-refundable. Failure to notify host or instructor prior to clinic date forfeits the ability to transfer. *
Should be Empty:

Student Registration Form