Canadian Snowbird Association

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Canada Clubs! - Placemats Order Form

Fields marked with an asterisk (*) must be entered.
Contact Information
* Title:
* First Name:
* Last Name:
* Canadian Contact Telephone Number:
* US Contact Telephone Number:
* Contact E-mail Address:

Canada Club! Information
* Name of Canada Club! Event:
* Location of Event (i.e. Park Name):
* Date of Event:	,
* Time of Event:
Description of Event:

Mailing Instructions
* Number of Placemats Required:
* Requested Delivery Date:	,
Mailing Address for Placemats
* Care of:
* Street Number:
* Street Name:
Other:
* City:
* State / Province:
* Zip / Postal Code: