Evening Gas Technician 2 Request to Register Form If you require an alternate set-up of this form, please email wes@durhamcollege.ca. Registration is by this form only and is first come, first served basis. Whitby Enrolment Services will email you within 7 – 10 days after form submission with further information. Name* First Last Student Number* Untitled I do not know or do not have a student number Mailing address* Street Address City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal code Telephone Number*Email* Country of Citizenship* Country of Birth* Language at Birth* Registration Information*We require proof of your completed Gas technician 3 license at time of registration. Failure to submit your TSSA GT3 license before classes begin may result in a withdrawal with no refund. Please check one of the following boxes. I can attach a copy of my valid TSSA GT3 License I can attach proof of registration for the GT3 course. I understand GT3 needs to be completed before GT2 classes begin. Attach a document*Accepted file types: jpg, gif, png, pdf, Max. file size: 15 MB.Payment Options Please do not pay until we contact you by email.Withdrawal Information You are academically and financially responsible for your course unless you officially withdraw by the start of the third class. Failure to attend does not constitute withdrawal. A Professional and Part-time Learning Course Withdrawal Form must be emailed to wes@durhamcollege.ca by the start of the third class if you wish to withdraw. Withdrawals before the third class are subject to a $30 admin fee and refunds are completed by e-transfer.Consent Declaration By submitting this form, I declare the above information to be true and accurate to the best of my knowledge including all forms uploaded as of the date of submissionEmailThis field is for validation purposes and should be left unchanged. Notice of collection: In accordance with Section 39(2) of the Freedom of Information and Protection of Privacy Act, 1990, the personal information collected on this form is collected under the legal authority of the Ontario Colleges of Applied Arts and Technology Act, 2002 and may be used and/or disclosed for use with Enrolment Services. Your personal information may also be used for various administrative, statistical and/or research purposes of the College and/or ministries and agencies of the Government of Ontario and the Government of Canada. If you have any questions about the collection, use and disclosure of your personal information by the College, please contact the Freedom of Information and Protection of Privacy Coordinator, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, 905.721.2000 ext. 3292.