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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 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