CENTRAL ALBERTA BRANCH REGISTRATION FORM
Reynolds Alberta Museum Tour, Wetaskiwin
June 7, 2003

Must be received by Shirley Layne no later than 4:00pm, Tuesday, June 3, 2003.
Please mail or fax (780-425-1722) this registration form to:
Shirley Layne, CMP - Special Events Coordinator
APEGGA - Reynolds Museum Tour - June/03 tour
1500 Scotia One, 10060 Jasper Avenue
Edmonton, Alberta T5J 4A2
 
Full Name : 
 Required
Street Address : 
 Required
City or Town : 
 Required
Phone : 
Zip / Postal Code : 
 Required
Email : 
 Required
Cheque Enclosed:
Yes
Credit Card : 
Card Number : 
Expiry Date : 
     

"Friends of Museum" members

( # Adults ) X $ 18 per person = $
( # Children under 12 ) X $ 7 per person = $
Total
= $
Not "Friends of Museum" members
   
( # Adults ) X $ 25 per person = $
( # Children under 12 ) X $ 12 per person = $
 
Total
 = $