Legal LAST NAME

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Legal FIRST NAME

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Middle Name(s)

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Street Address and Unit Number   

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City / Town

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Province/State

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Country

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Postal/Zip

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Home phone

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Cell phone

Email address

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Date of Birth

mm dd yyyy *

Gender

Male Female

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Yes No

Yes No

Program of Interest

Audio Engineering & Production Film & Digital Arts Film & Music Business Not Sure *

Start Date

May 2012 September 2012 January 2013 Not Sure *

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How did you hear of PAVI?
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Application Fee is $150 CDN for Canadian citizens and landed immigrants, $250 CDN for international students, and must be paid in Canadian funds.  Application Fee is non-refundable.  To complete the submission of your application we will contact you for payment of your application fee (payable by credit card, cheque, money order or bank wire).

I declare that the information contained in this application is complete and correct.

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