Please fill out and submit the following registration form to become a Member of the Central Vancouver Island Multicultural International Student Social Services Program.
Date:*
Name:*
Age:*
Gender:* Female
Home Country Address: *
City:*
State/Province:
Country:*
Telephone:*
Email:
PERMANENT NANAIMO RESIDENCE
Please fill out the following if you already have a permanent residence in Nanaimo.
Nanaimo Address:
Nanaimo Telephone:
Nanaimo Cell Phone:
Nanaimo Email:
If you do not yet have a permanent address in Nanaimo, please provide the address and telephone number of where you will stay on arrival
Arrival Address:
Arrival Telephone:
If you do not yet know where you are staying on arrival you have the option of either registering for our Airport Pick Up & Orientation service, in which case we will assist you in finding temporary accommodation or contacting us when you have permanent residence in Nanaimo with your new contact information.
EMERGENCY INFORMATION
Please fill out emergency contact numbers for both your Home Country and in Nanaimo [If you presently do not have a family member or friend in Nanaimo we can contact in case of emergency then you can give us that contact information when and if it is available].
HOME EMERGENCY CONTACT
Emergency Contact Name: *
Relationship of Contact: *
Emergency Contact Phone Number: *
NANAIMO EMERGENCY CONTACT
Emergency Contact Name:
Relationship of Contact:
Emergency Contact Phone Number:
In the space below please give us details on any medical condition, allergies, or special diets you feel we should know in case of an emergency:
SCHOOLING INFORMATION
Where have you attended school in Nanaimo? *
How long have you been attending school in Nanaimo? *
This is my first year
This is my second year
This is my third year
This is my fourth year
Longer than four years
MEMBERSHIP INFORMATION
Are you re-registering or have you ever been a member of the CVIMS International Student Program? * Yes
If the answer is yes, in the space below please give us your past Membership Number:
For which membership package are you registering? *
1. Membership Package # 1
Are you are also registering for our Airport Pick Up & Orientation Service as part of your Membership Package #1? Yes
For which semester are you registering your Membership? Spring
2. Membership Package # 2
For which month are you registering your membership?
-- Select One --
January
February
March
April
May
June
July
August
September
October
November
December
3. Membership Package # 3
For which semester are you registering your Membership? Spring
MEMBERSHIP SERVICES
To better assist us in preparing to serve you as a Member of our International Student Social Services Program please give us an indication of the types of services you might be interested in. Please note you are not, in any way, obligated to or limited by the answers you give and the services indicated.
Airport Pickup and Orientation Service
Counseling and Information Services
1. Settlement and Orientation
2. Money Management
3. Government Services, Systems, Regulations and Requirements
4. Travel & Family
5. Legal and Emergency Services
6. Emergency Services
Workshops
1. Becoming a driver in Canada
2. Government and the Law
3. Money Management
4. Employment and Canadian Workplace Culture
PAYMENT OPTIONS
Please select your form of payment *
Once we have received your registration and processed your payment you will receive confirmation of your Membership and Membership Number by your preferred method as indicated below *
Email my confirmation to the following address:
OR
Mail my confirmation to following address:*
