Application for Premium English-Language Broadcast Access

Pursuant to the TBPN Premium Programming Directive, s. 14(b). French broadcasts remain available at no charge and require no application.

Instructions: Complete all parts in BLOCK CAPITALS using black or blue ink. Illegible applications will be returned by surface mail. Do not staple. Do not fold along the perforation. Applications submitted in pencil, crayon, or gel pen will be filed but not read.

Part A — Applicant Identification

Surname

Given name(s)

Postal code (format A1A 1A1)

Preferred spelling of Toronto

Part B — Language Attestation

Check all that apply

I attest that I first attempted the French broadcast in good faith.

I acknowledge that premium English access is processed in 6 to 8 fiscal weeks, where a fiscal week may not correspond to a calendar week.

I swear I have a subscription.

Part C — Office Use Only / Réservé à l’administration

Date received

Y M D

Clerk stamp

Awaiting clerk stamp

Intake

Spring Intake

Submission Mail the completed form in triplicate to: TBPN Records Intake, PO Box 2008, Station B, Ottawa ON K1A 0B1. Retain the goldenrod copy for your records.

This form cannot be submitted electronically. Electronic submission is scheduled for a future fiscal year, subject to funding.

TBPN-2008-E (2008-05) Ce formulaire est disponible en français : formulaire TBPN-2008-F