First Name*
Maximum length of 30 alpha characters, no special characters and no punctuation except hyphen(-) and ampersand (&) if applicable.
First Name is a required field
LAST NAME*
Maximum length of 30 alpha characters, no special characters and no punctuation except hyphen(-) and ampersand (&) if applicable.
Last Name is a required field
ADDRESS*
Maximum length of 50 characters. Format of APARTMENT Number should be STREET NUMBER, STREET NAME with a trailing APARTMENT/SUITE number.
Address is a required field
City*
Maximum length of 35 alpha characters and greater than one character, no special characters and no punctuation except hyphen(-) and ampersand (&) if applicable.
City is a required field
Province *
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
POSTAL CODE*
Length of 6 characters, no punctuation or spaces Format of: FSA - Alpha/Numeric/Alpha (3) LDU – Numeric/Alpha/Numeric (3)
Required
PHONE NUMBER*
Numeric only, no punctuation or spaces Format of: Area Code (3) Phone Number (7)
Phone number is a required field
Email*
Combination of alpha and numeric digits permitted Upper and lower case permitted. String should include the @ sign and a “.”
Email is a required field
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