BANFF CENTRE FOR ARTS AND CREATIVITY Please complete this form and return it via e-mail to registrars_office@banffcentre.ca Your Name 1.D, Number (example: 516123456) Powwio Cesae Cioai Vine S201U2208 Emergency Contact Details Name Relationship Karunets Lage Gioveiend Emergency Contact Mailing Address Is The Same As Yours? O ves No Address City WA Oup Poxp Qo Great New Province / State / Region Postal / Zip Code New Youe 003 Country . aE af Phone Alternate Phone E-mail +4 (516) for 0104 BAPINE NAvioRiA@GMAiL.-Cod OFFICE OF THE REGISTRAR « Tel: 1.403.762.6180 + 1.800.565.9989 Box 1020, 107 Tunnel Mountain Drive, Banff, Alberta, Canada T1L 1H5 + www.banffcentre.ca This information is collected under the authority of the Post- Secondary Learning Act, Revised Statutes of Alberta. This Act mandates the programs and services offered by The Banff Centre. The information you provide here wil be protected by the provisions ofthe Alberta Freedom of Information and Protection of Privacy Act. For inquires about the collection and use ofthis information, or to remove your ame from our mailing list, please contact the Reglstrar, Office of the Registrar, The Banff Centre, PO Box 1020, Stn 26; Banff, Alberta ‘THL AHS; 403 762 6180. \