Canadian Employee Relocation Professional (CERP™) Designation -
Registration Request

 

Items marked with an * are required fields.
Click Here to open a printable (PDF, 20 KB) version of the Registration Form
Please complete the information below
 Name: *
 Title: *
 Organization:
 Street Address: *
 City: *
 Province/State: *
 Postal Code/Zip: *
 Telehone Number: *
 Date of Birth: *
 Email: *
 Website:
* Please Indicate:


 

Member #:

Have you ever registered for a course/ seminar at Centennial College?

If yes, please provide your student number:

* Course Selection (Choose one)




* Semester (Choose one)



* Payment Info (please select card type):

 

 Card Number: *
 Expiry Date: *
 Name on Card: *
 Waiver for Signature: *
Given that this program is taught in partnership with CERC, Centennial College requires your signature to release certain information to the CERC organization. Please read and check the box below if you agree:

I hereby authorize Centennial College to release the following information to the CERC organization related to my enrolment and my history as a student in the above mentioned program: Contact Information, Membership Information, Transcript of Marks/Grades, Class Attendance Report, Classroom Performance, and Program Withdrawal.
I also hereby agree to save harmless Centennial College from any present or future claims by myself, my heirs, or assigns for releasing the above listed history to the CERC organization.
*