APPLICATION FOR THE CANADIAN TEAM 1998

Surname/
Nom de famille_______________________________		 First Name/
Prénom_______________________________
Sex/
Sexe____________________________________		 Home Town/
Ville natale____________________________

Date of Birth/
Date de naissance___________________________________________________________________________

(MM/MM/DD/JJ/YEAR/ANNÉE)
Place of Birth/
Lieu de naissance__________________________		 Citizenship/
Citoyenneté____________________________
Passport No/
N de passeport____________________________

Expiry Date/
Date d'expiration________________________

(MM/MM/DD/JJ/YEAR/ANNÉE)
Sport
Sport__________________________________________________________________________________
Event(s)/
Evénement(s)___________________________________________________________________________
Athlete/
Athlete		 Coach/
Entraineur		 Manager/
Gérant		 Other/
Autre
Address/Adresse
_______________________________________

_______________________________________

_______________________________________

_______________________________________		 NEXT OF KIN / PLUS PROCHE PARENT
Name/Nom____________________________

Address/Adresse________________________

______________________________________

______________________________________
Telephone/Téléphone
Day/Jour_______________________________

Night/Soir______________________________		 Telephone/Téléphone
Day/Jour_______________________________

Night/Soir______________________________
Languages Spoken/Langues Parlées
English______ Français_______
Other/Autre_________________		 Relation to you/ Lien de Parenté
______________________________________
__________________________
Signature/Signature
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