Notice of Intent to Participate / Application for Intervenor

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I. Applicant

Name:

Address:

Telephone Number:

Facsimile Number:

II. Identification of Proceedings

Describe the proceedings in which you wish to be heard (Tribunal file number or case name):

III. Applicant's Status

Which of the following best describes your status:

______ Artist ______ Producer

______ Other interested person or organization

______ Artists Association ______ Producers Association

IV. Status of Applicant

Please select one of the following:

______ I am an intervenor as of right and intend to participate in the above described proceedings.

______ I wish to apply for permission to intervene in the above described proceedings. (Please describe the contribution you expect to make to the proceedings if granted permission to intervene; use additional sheets if necessary):

Signature of Applicant or Authorized Representative:

Date:

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

Form 6 (02/2006)

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