Return to CRM Registration Information
Print Out Registration Form from Web Site
Miss / Mr
Mrs/Ms __________________________ _________________________________
first name last name
______________________________________________ ______________________
address phone
__________________________ _________________ _______________________
city if other than Winnipeg postal code e-mail
Course No. Course Name $ Amount$
___________ __________________________________________ ___________
___________ __________________________________________ ___________
___________ __________________________________________ ___________
___________ __________________________________________ ___________
___________ __________________________________________ ___________
___________ __________________________________________ ___________
___________ __________________________________________ ___________
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