SEMINAR ON CHATS – Community
Home Assistance to Seniors

Thursday, May 20, 2010


TO REGISTER:
1. Complete this form on screen.
2. Print out the completed form.
4. Write cheque payable to RTO District 34
5. Mail cheque and completed form to:

Susan Leppington
7 Ironshield Cres.,
Thornhill. Ontario
L3T 3K7

Closing date for registration: Thursday, May 13, 2010

N.B. PLEASE WRITE SEPARATE CHEQUES FOR EACH FUNCTION

MEMBER'S NAME (Type name in box)

ADDRESS (Type address in box)

PHONE NUMBER (Type number in box)

ADDITIONAL NAMES (Type names in box)
AMOUNT OF CHEQUE (Use arrow to select)
 
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