Immigration registration form

Personal information

Last name*

First names*

Address*

City*

Province/State*

Postal code*

Current country of residence*

Country before immigration (if in Canada)*

Birth date*

Country of birth*

Gender*

Female

Male

Trans

Prefer not to disclose

Primary Language*

French language level*

English language level*

Current immigration status*

Returning Canadian*

Yes

No

Date of entry to Canada*

Primary phone*

Secondary phone

Primary email*

Secondary email

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