*Family Name:
*Contact Name:
*Street Address:
*City / Town:
*Province:
*Postal Code:
*Phone number:
Work number:
*Email:

*Name of Registrant #1:
*Birthdate:
*Level:
*Program Code: Note: T5, T7, T8, J10, J19, HS1, HD1, and HD3 are Full
*Rentals (Y/N):

Name of Registrant #2:
Birthdate:
Level:
Program Code:
Rentals (Y/N):
*Terms & Conditions:
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