Print this form and send:
By Fax: 1-780-488-3757
By mail to: ACCD, 106, 10423 178 Street NW, Edmonton AB T5S 1R5
If paying by cheque or money order, please mail order form with payment.
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Company: |
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Contact Person: |
__________________________ |
Phone: |
_________________ | |
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Address: |
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| Crystal Sponsorship: | Single Tickets to Champagne in the Showroom: | |||
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___ X $500 = |
___________ |
___ X $75.00 = |
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Total |
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Total |
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| Method of payment: | ||||
| Cheque enclosed (please make payable to ACCD) | ||||
| Visa |
Card Number: |
___________________ |
Expiry Date: |
____/_____ |
| MasterCard |
Card Number: |
___________________ |
Expiry Date: |
____/_____ |
Signature: |
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