Personal Information

Name
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(Last)	(First)
Permanent Address
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(Street/P.O Box)	(City/Town)	(Province)
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(Postal Code)	(Telephone)	(E-Mail)

High School
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(School Name)	(Location)	(Grade)

Enrollment Information

Date of Workshop Requested

Please select one September 18th September 25th October 2nd October 16th Please select an item.