675 Queen St. S.
Suite 208
Kitchener, Ontario
N2M 1A1

Tel: (519) 746-1242
Fax: (519) 746-2929

CIC Youth Chapter:
Elections Study Group Registration


On-line Registration Form for Elections Study Group



Name:

Phone:

Email:

Age:

Gender:
Female Male

Occupation / University / Department:

Riding of Residence:

Name of MP:

Previous Political Work:

Party: