Student Ambassadors of Eastern Townships : Registration form (version française)

 

Last Name :
Fist Name :
Title :	M. Mlle Mme
Phone number : (819) 555-5555 # XX
Adress :
City :
Postal Code :
Email :
Age :
Canadian status :	Canadian Citizen Permanent Resident Foreigne Student
Country of origin :
Mother tongue :
Study program :
University :	Sherbrooke University Bishop's University
Realisation :
Full-time Student :	YES NO
Centers of interests : mention your preferences
How did you get the information :	Festival Traditions du Monde Student newspapers Poster	Website Phone Others
Please verify your data before submiting the form .