Registration Form - Miramichi Member Luncheon

Details:
Thursday, September 16th, 2010
Park Inn & Suites - 1 Jane Street, Miramichi
12:00 Noon
$17.70 + 2.30 HST = $20.00 (HST #R122270739)

REGISTRATION DEADLINE IS Noon, Tuesday, September 14th.

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 :
	Please pay via online banking or mail a cheque in the amount of $20.00 to: NBICA 55 Union Street, Ste.250 Saint John, NB E2L 5B7 Thanks!