Online Student Application Form

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Wednesday, September 08, 2010, 5:45:33 AM 1. Registrant Information Preferred Mailing Address: Residence Permanent First Name: Last Name: Residence Address: Address 1: Address 2: City/Town: Province: Postal Code: Telephone Number: Permanent Address: Same as above: Address 1: Address 2: City/Town: Province: Postal Code: Telephone Number: Preferred Email Address: Birth Date: Month: Day: Year: Gender: Male Female Language Spoken: English French Other: 2. University University of Ottawa Queen's University University of Toronto McMaster University University of Western Ontario Other    Graduation Year: 3. Release of Information: I consent to the publication/communication of my name, address and contact information for the following purposes: LMS PROLINK (OSOTs Insurance Broker) Sykes Canada Corp. (OSOTs Legal Advisory Service) Recruitment Advertising Course/Workshop Advertising Promotion Please enter the characters exactly how you see them on the image above: