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< Living Alive > T-shirt design contest online submission

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First Name*:

Last Name*:

Phone Number*:

Email Address*:

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Address line 1*:

Address line 2 :

City*:

Province / Territory*:

Postal Code*:

Age Range*:

Gender*:

Place of Birth*:

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How long have you been in Canada?*:

Where did you hear about this event?*:

Program Highlight	Email	Facebook
Newspaper	TV	Radio
Friend	Parent	Church
Booth	Others

Is the logo on the front or back of the T-shirt*:

Front
Back

Upload your T-shirt design: *

IMPORTANT:
1. Please upload the file no larger than 5Mb. Otherwise, we may not be able to get the image uploaded. (note: jpg, gif, pdf, png only)
2. Please only use English file name with no space and special characters.

* Please note that this process may take a few miutes, please do not close the browser, nor refresh the page, or the upload process will not be able to complete.