Last Name:
First Name:
Address:
City:
Postal Code:
Date Of Birth:
Sex: Male or Female (please circle)
Telephone (home):
Telephone (work):
Health Insurance Card No:
Email:
In person: September 1, 2009. 6:30 PM to 7:30 PM
Cynthia-Coull Arena
By Mail: Before August 30, 2009 by filling out the registration form and sending it along with your cheque made out to CPA Greenfield Park FSC to the following address:
PO Box 51512
3848 Taschereau
Greenfield Park, Quebec
J4V 3N8