Life License Qualification Program Examinations

EXAM SCHEDULE • REGISTRATION • TERMS/POLICIES/CONDITIONS

You may enter your registration request directly online using these pages. Alternately, you may choose to print the registration information and either fax or mail it to us.

Confirmations will be sent via email, fax, or phone at least 5 business days prior to the scheduled exam. If you arrive at the examination centre without receiving a confirmation of registration you may not be able to write the exam. Please read our "Confirmation" policy in the Terms/Policies/Conditions.

Please read the Terms/Policies/Conditions Sheet and Exam Schedule information before filling out this form.
If FAXing or mailing your registration request, please print clearly and accurately fill in all the information required accurately.
All money orders are to be made payable to Durham College.
All registrations requests are subject to availability restrictions on a first come first served basis [Web registrations, Fax registrations, and then Phone registrations]

Refund Policy: Once your exam is booked, there are no refunds or cancellations available. Rescheduling of an exam is at the discrection of the Administration Centre and will only be allowed under very special circumstances. Please read our "Refund" policy in the Terms/Policies/Conditions.

If you plan to pay by money order or certified cheque, YOUR MONEY ORDER/CERTIFIED CHEQUE MUST ACCOMPANY YOUR REGISTRATION FORM and be mailed to Durham College and must be received seven (7) business days prior to the date you request to write.

NOTE: Until your payment is received, you will not be registered and we can not hold a seat for you. This includes declined credit cards as well as money orders and certified cheques.

Durham College
1610 Champlain Avenue, Whitby, ON L1N 6A7
Tél: (905)721-3341 / 1-800-816-3615 Fax: (905)721-3345

Gender:

First & Middle Name:

Last Name:

Home Address:
Apt., Street or Box No. City/Town:

Province: Postal Code:

E-mail:
* This is our preferred method of confirming your exam and releasing your marks.
Caution: If using a Hotmail account, your confirmation/marks may go to your junk-mail folder.

Verify your e-mail:

Home Phone Number: ( )

Business Phone Number: ( ) ext.

Mobile Phone Number: ( )

Fax Number: ( )

Please do not register for the licensing exam without your certificate of LLQP course completion.

Do you have your certificate of completion? yes no

Date issued: Month: Year:

Who is your course provider?

Exam type:
Full Life (4 Hrs)
Accident Sickness (2 Hrs)

Please select an exam location and date:

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Gender:
First & Middle Name:
Last Name:
Home Address:	Apt., Street or Box No.	City/Town:
Province:		Postal Code:
E-mail:	* This is our preferred method of confirming your exam and releasing your marks. Caution: If using a Hotmail account, your confirmation/marks may go to your junk-mail folder.
Verify your e-mail:
Home Phone Number:	( )
Business Phone Number:	( ) ext.
Mobile Phone Number:	( )
Fax Number:	( )