NAME
*
First Name
Middle Name
Last Name
GENDER
*
Please Select
Male
Female
DATE OF BIRTH
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
PLACE OF BIRTH
*
SCHOOL
*
GRADE
*
PROJECTED DATE OF HIGH SCHOOL GRADUATION
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
NATIONALITY
*
PHONE NUMBER
*
Please enter a valid phone number.
Format: (000) 000-0000.
EMAIL
*
example@example.com
NATIONAL INSURANCE #
*
PASSPORT #
*
T-SHIRT SIZE
*
XS
S
M
L
XL
XXL
A PASSPORT SIZED PHOTO
*
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REASON FOR WANTING TO BE A PART OF THE MARITIME CADET PROGRAMME
*
CAREER GOALS
*
EXTRACURRICULAR ACTIVITIES AND POSITIONS
CLUB AND ORGANIZERS
PARENT/GUARDIANS NAME
*
First Name
Last Name
EMERGENCY CONTACT
FULL NAME
*
First Name
Last Name
RELATIONSHIP
*
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PHONE NUMBER
*
Please enter a valid phone number.
Format: (000) 000-0000.
PARENT/GUARDIAN SIGNATURE
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