Application for Review

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I. Applicant

Name:

Address:

Telephone Number:

Facsimile Number:

II. Other Parties Affected

Provide the name and address of any artist, artists association, producer or producers association affected by this application (use additional sheets if necessary):

III. Details of Application

Tribunal file number and date of the decision or order which you wish to have reviewed:

Provide a description of the facts which would justify a review of the decision or order (use additional sheets if necessary):

Please attach copies of any relevant documents.

IV. Description of Decision or Order which the Applicant is Seeking

What decision or order do you wish the Tribunal make?(use additional sheets if necessary):

V. Language of Choice for Tribunal Proceedings

______ English ______ French ______ Bilingual

Signature of Applicant or Authorized Representative :

Date :

Name and address of Applicant's Authorized Representative, if any:

Form 5 (02/2006)

Send Completed Form To:
Canadian Artists and Producers Professional
Relations Tribunal
240 Sparks Street, 1st Floor West
Ottawa, Ontario  K1A 1A1