Enrollment Form Enrollment Information First Name Last Name Email Phone (###) ### #### Introduce Yourself (Note Area): Personal/Professional Biography. Spoken Languages * Please indicate which languages you can speak. Please indicate your level of fluency including both written and spoken. Home Address Address 1 Address 2 City State/Province Zip/Postal Code Country Employer Information Job Title Date of Hire or Promotion Date of Hire or Promotion to the position of Credit Counsellor within an accredited non-profit credit counselling agency. Credit counsellors must achieve their AFCC within three years of promotion or hire to the position with the agency. This field is required if you work for any accredited non-profit credit counselling agency in Canada. MM DD YYYY Employer Employer Address Address 1 Address 2 City State/Province Zip/Postal Code Country Website http:// Preferred Method of Contact* Phone E-mail Ship Materials To: Home Address Employer Address Total: $ 1,899.00 CAD
