Name:___________________________________________________ Age:_________

Address:______________________________________________________________

City:_________________________________ Province:________________________

Postal Code:___________________________________________________________

Home Telephone:____________________ Business Telephone:__________________

Fax:______________________ Email:______________________________________

Occupation:(if student, please name school, program, level)___________________

______________________________________________________________________

A non-refundable deposit of $200 dollars is required to reserve a place in upcoming classes prior to the commencement of the first class.

Enrollment is limited to 12 students per class.