Registration Form - Bathurst Member Dinner

Details:
Wednesday, September 15th, 2010
Atlantic Host Inn - 1450 Vanier Blvd., Exit 310 on Rte.11

Reception: 6:30 p.m.
Dinner: 7:00 p.m.

There is NO CHARGE to attend, however, you must pre-register.

Please complete below registration form:

Name / Nom :
Organization / Organisation :
Address / Adresse :
City / Ville :
Province / State :
Postal Code / Code postal :
Phone / Téléphone :
Fax / Télécopieur :
E-mail / Courrier électronique :