MËMËGWASHI formulaire

Registration form
Mëmëgwashi gala

Eligibility criteria is simple:
students must be Inuit, Metis
or from a First Nation and attend an educational institution in Val-d’Or.

* Indicates required field

First Name *

Last Name *

Gender *

Male Female

Age *

Address *

Apartment *

City *

Phone Number *

Cell Phone *

Postal Code *

E-Mail *

Name of institution attended *

Write Merit Text *

Parent or Tutor's Name *

Or Teacher's Name *

By registering, the student and / or tutor agree that the Val-d'Or Native Friendship Centre use the picture for the intended purposes. *

Yes

By checking yes, you authorize the registration of the student. *

Yes No

Information - Registration
Jessica Daigle-Bourdon
819 825-8299 poste 240
Jessica.daigle-bourdon@caavd.ca
www.facebook.com/caavd

Submit