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ENROLLMENT FORM 2001E
I apply to enroll for the above Examination


Membership No.
________________________________________________________________________

Name
________________________________________________________________________

Address
________________________________________________________________________

Tel: ___________________________

DATES AND MODULES
MODULE(S):
#1 ________ #2 ________ #3 ________
#4 ________ #5 ________ #6 ________

FEES: $_______
GST 7%: $_______
TOTAL FEES ENCLOSED: $_______


Dates and Test Centers (in order of preference)

1. Date______________________ Center_____________________

2. Date______________________ Center_____________________

Single Module $80.00
2 or more Modules on same day $70.00ea.
6 Modules prepaid $380.00


I agree to abide by the conditions of enrollment as laid down by the Grooming Institute of Canada.

Signed_____________________________________ Date_____________

Please make cheques payable to the Grooming Institute of Canada and mail to:
92 Lakeshore Road East
Concourse Level
Mississauga, Ontario
L5G 4S2
Tel: 905-278-9663
Fax: 905-278-1045

Code 0299