MD"A" FORUM 2002
The "How To" Forum

AMBASSADOR RESORT

1150 Princess Street, Kingston, ON

Oct 18-20, 2002

(NB: Please complete ONE Form for EACH registrant)

Name

____________________________________________ (Type or Print Clearly)

Mailing Address

____________________________________________

____________________________________________

Postal Code

____________

 E-mail: __________________________

Phone

( ___ ) _____________

Fax  ( ___ ) ___________

District A-___

If this is your FIRST Forum ..... Please Mark with an "X" o

Registration $90.00 each ( include 3 meals)

Sat. Lunch & Dinner ... Sun. Breakfast

First Night Room Deposit Required $92.00

(taxes NOT included)

IF YOU HAVE ANY SPECIAL DIETARY OR PHYSICAL NEEDS, PLEASE ADVISE!

Room Choice: Standard ONLY (sleeps 2-4 people)

If Sharing Accommodations state other party’s Name: ______________________________

Cheque enclosed in the Amount of: $ _____________

Cancellation Date: Sept. 15, 2002 (Refund with written notification supplied)

NO REFUNDS AFTER SEPT. 30, 2002

Make cheques payable to ........ M D "A" Forum

(NO POST-DATED CHEQUES ACCEPTED)

Return completed form including registration and room deposit to:
PDG Lion Walt Grieve • 758 Galloway Cr • London, ON N6J 2Y7

Email: waltgrieve@golden.net

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