2019-03-06_ruthkathleenpelletier_FINAL -Registration Form - MAY 3rd HOUSING WHAT'S NEXT CONFERENCE Mar 5th RP-LB(1).pdf

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A SENIORS NETWORK… FOR SENIORS…BY SENIORS  
 
Conference  
Housing:  What`s Next?  
May 3rd, 2019      8:30 A.M - 4:00 P.M.  
HOTEL RUBY FOO’S  
7655 boul.Décarie, Montréal,QC H4P 2H2  
 
Registration Form * 
Deadline to receive cheque and form April 20th , 201 9 
                       
Please Print     One (1) Form per person  
 
Name : _____________________ _ ______________ ___________  
 
Address:  ____ ______________________________________  
 
Telephone: ____________ _____               Cell:  _________________ _______  
 
Email:  _____________________________________________  
 
Payment can be made Online: www.seniorsactionquebec.ca  
 
Indicate if for an  Individual  or a Kiosk _ ________ ______________ __ 
 
Payment Made : $_________ _  
 
Indicate on Cheque Memo line: Conference registration, or Kiosk  
                 
*If paying by cheque include a copy of the registration form, cheque and mail to:  
 
Seniors Action Quebec  
1857 Du Maisonneuve Ouest , Suite 304, Montré al, QC. H3H 1J9  
________________________________________________________  
 
*Email  copy of  registration form to: ruthkathleenpelletier@gmail.com  
 
*PLEASE INDICATE FOOD ALLERGIES & DIETARY RESTRICTION  
 
______________________________ ______________________________ ______ _______ _____