Miss / Mr
Mrs/Ms   __________________________   _________________________________
         first name                   last name
______________________________________________   ______________________
address                                          phone
__________________________   _________________  _______________________
city if other than Winnipeg  postal code        e-mail

Course No.     Course Name                                   $ Amount$
___________    __________________________________________   ___________

___________    __________________________________________   ___________

___________    __________________________________________   ___________

___________    __________________________________________   ___________

___________    __________________________________________   ___________

___________    __________________________________________   ___________

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   Annual Membership $32 indivdual/$57 couple fee enclosed: ___________

    Yes, I would like to make a TAX DEDUCTIBLE DONATION of: ___________

                   CRM Tickets to Annual Lunch at $50 each: ___________

      I would like to sit with: ___________________________
                                                   Total    ___________

Pay by (circle one) Visa  Mastercard  Cheque

Card number __________________________ Expiry date ____________________

Signature   __________________________


          Cheques payable to the order of Creative Retirement Manitoba
   270 Sherbrook St., Winnipeg, MB R3C 2B9 fax: 957-7839  phone: 949-2565