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


Course Name                                 Course number    Fee Amount
1________________________________________    _____________   ___________

2________________________________________    _____________   ___________

3________________________________________    _____________   ___________

4________________________________________    _____________   ___________

5________________________________________    _____________   ___________

6________________________________________    _____________   ___________

                                          Course SubTotal    ___________ 

  Annual Membership$ 40 indivdual/$70 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   __________________________ V Code _______________


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