Leading Ladies - Application
Full Name
First *
Last *

Date of Birth *

MM 		/
DD 		/
YYYY
Street Address *
Appt. or Unit #
City *
State / Province / Region *
Postal / Zip Code *
Country *
Phone *

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Email *

School/Community Group (If Applicable)
Please provide a reference (i.e. teacher, mentor, employer) and their phone number.
Please tell us what transit you will use to get to the program including TTC (specify adult or student), GO, Viva, Mississauga transit, etc. Please specify what stations you need to get on and off at so we can provide the correct transit ticket(s).
One written paragraph:

Sometimes we are inspired to create something or become more like someone. Who or what inspires you? Why?

This program is generously sponsored by TELUS Youth Outreach. Public Support: Canada Council for the Arts, Ontario Arts Council, Toronto Arts Council.