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                                                                    APPLICATION FOR THE TRYOUT




List any pertinent medical Conditions (asthma,diabetes,allergies,etc)_____________________________________________


_________________________________________________________________________________________________________




Do you have a passport? Yes or Not (circle one)   From what country:_____________________________________________




Do you have a Dual Citizenship with another country? If so,which country?:________________________________________



If you are not Canadian Citizen,please indicate your Nationality and residence status:________________________________




Please indicate the BIRTHPLACE for each of the following:                             Yourself: _________________________________  




Mother:______________________                                               Maternal Grandmother:  __________________________________




Father:_______________________                                              Maternal Grandfather:    __________________________________   




Paternal Grandmother:____________________                        Paternal Grandfather:     ___________________________________





our Agent's Name:_______________________                           Agent's e-mail :         _____________________________________




Agent's Phone :(___) __________________                                  Agent's Fax  :            ______________________________________







Agent's Address:______________________________________________________________________________________________








Agent's Web Site: www._________________________________________________________________________________________





______________________________________________________________________________________________________________

                                                                                                                                         
                                                                                                                                                                                                                                                                
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