CITA :: ONLINE REGISTRATION

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	REGISTRATION POLICIES AND PROCEDURES

ONLINE REGISTRATION :: STEP 2 of 3

COURSE INFORMATION
Course Title:
Course #:
Tuition Fee:
Please fill in and submit the following Registration Form Fields indicated with an asterisk (*) are required.
PERSONAL INFORMATION
* Title:
* Name:
* Surname:
* Date of Birth (DD/MM/YYYY) :
* Country of Birth:
* Mother Tongue:
* Level of Education:
CONTACT INFORMATION
* Street # and Name:
Apt./Unit #:
* City:
Province/State:
* Postal Code:
* Country:
Mailing Address: (IF DIFFERENT FROM THE ABOVE)
* Home Phone #:
Business Phone #:
Cellular Phone #:
* Email Address:
EMPLOYMENT INFORMATION
* Currently I am:	Employed (Full-Time) (Please state below employer's name and your position) Employed (Part-Time) (Please state below employer's name, your position) Self-employed (Please state below type of business) Student (Please state below name of school) Other (Please specify below)
* Are you or your employer engaged in immigration business?	Yes No
CITA ONLINE
* Your Username with CITA Online:
ADDITIONAL INFORMATION
* CISeN:	Would you like to subscribe to FREE Canadian Immigration SOLUTIONS e-Newsletter (CISeN)? YesNo
Additional Information:	If you would like to provide us with any additional information, please use space below:
DECLARATION
* Declaration:	By submitting this Registration Form, I hereby certify that: 1. All statements on this form are correct and complete. 2. I have read and have understood CITA REGISTRATION POLICIES AND PROCEDURES. 3. I understand that misrepresentation of this data may result in admission to or registration in CITA being rescinded.
* Date (DD/MM/YYYY) :
PAYMENT INFORMATION
PLEASE NOTE: Upon submission of this Registration Form, you will be transferred to PayPal secure payment site to make your payment. PayPal is a safe and FREE way to pay online. Available payment options: ( )