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Canada Club! Order Placemats Form
Fields marked with an asterisk (*) must be entered.
Contact Information
Title *:
First name*:
Last name*:
CSA Membership Number*:
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*:
Security Code (Case sensitive) *:





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