| 1.
Name: |
_____________________________________
|
| Address: |
|
| Home
No.: |
______________________
|
Listed |
| Office
No.: |
______________________
|
| Citizenship: |
|
| Country
of origin: |
Canadian
Landed Immigrant
Other ______________
|
| Occupation: |
__________________________________
|
| Languages: |
__________________________________
|
| 2.
Spouse Name: |
__________________________________
|
| Occupation: |
__________________________________
|
| Citizenship: |
__________________________________
|
| Country
of origin: |
Canadian
Landed Immigrant
Other ____________
|
| Languages: |
__________________________________
|
| 3.
Children: All children under 16 register free. |
|
|
Name
|
Gender
( M/F)
|
Age
|
Education
Level |
| 1 |
|
|
|
|
| 2 |
|
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|
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| 3 |
|
|
|
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| 4 |
|
|
|
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| 5 |
|
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| 6 |
|
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|
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| 4.
Incase of Emergency please contact: |
| Name: |
_____________________________
|
| Relationship: |
_____________________________
|
| Telephone: |
_____________________________
|
| 5.
Would you like to volunteer to serve in a Committee?
Yes
No |
| Signature: |
_________________________
|
| Date: |
_________________________
|
