Questionnaire Text

Questionnaire form view entire document:  text  image

23. Where were you born? (Mark according to present boundaries.)
[] In Canada

Mark one box only
[] Newfoundland
[] Prince Edward Island
[] Nova Scotia
[] New Brunswick
[] Quebec
[] Ontario
[] Manitoba
[] Saskatchewan
[] Alberta
[] British Colombia
[] Yukon
[] Northwest Territories

[] Outside Canada

Mark one box only
[] United Kingdom
[] Italy
[] U.S.A.
[] West Germany
[] East Germany
[] Poland
[] Other (specify)