LLCA Adult Literacy Class Registration Form

The English Language Literacy Classes require payment of $50 before the first class.

Conversational Spanish requires a payment of $100 before the course start date.

You can e-Transfer i-learn@lloydlearningcouncil.org, or drop off a cheque or cash at the office: 202, 5009 48 Street, Lloydminster.
I have read and understand payment is required before I am fully registered for programming.*

YES
Coupon Code
Class/Event Name
Today's Date

MonthDayYear
Date
Full Name*

First NameLast Name
Year of Birth*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Food Allergies
What is your goal? What are you hoping to learn by the end of this class?*
Suggestions or topics you would like to be included in the workshop?
This personal information is collected for purposes of operating our education program pursuant to section 33(c) of the Freedom of Information and Protection of Privacy Act. If you have questions about this collection, please call: 780-875-5763

Refund Policy
- Refunds will be issued if a program is cancelled.
- Refunds will not be made after registration.
- Registration may be transferable to another person.
- Refunds may be made in the event of a personal emergency. Requests must be made in writing.
- $20 charge on all NSF cheques.
Adult Learning Demographics
Gender
Learner Age Group

0-1920-3435-5455+
Previous Schooling (highest level achieved)

No SchoolingGrades 1-6Grade 7-9Some High School or High School GraduateSome Post SecondaryPost-Secondary GraduateSpecial EducationUnknown
Learner Profile

First Nations/Metis/InuitPermanent/Temporary Residents/Refugees
Social/Economical Barrier(s)
Travel Distance (KMs)
Referred By

First NameLast Name
I authorize Lloydminster Learning Council Association to use names, photos and testimonials for awareness and promotion on social media.

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