Edcoms Registration Form
****
This form cannot yet be automatically submitted. Please print off this page and
fax
it to
1-902-742-9301
or
e-mail
the following information to us at
edcoms@ns.sympatico.ca
. Thank you.
****
Name:
Male.
Female.
Are you over 19?
Yes.
No.
Civic Address:
Address:
Town/City:
Postal Code:
Mailing Address:
If same as above, check:
Address:
Town/City:
Postal Code:
Type in your phone number:
Home:
Work:
E-Mail Address:
Please check the following that are applicable to you:
1. I am interested in discussing opportunities for an
Edcoms Presentation:
2. I am interested in having my name added to the Edcoms Parent and Community Support Network membership and mailing list and agree to receive updates from Kathy and Jim from time to time:
3. I would like to help to ensure that Kathy and Jim are able to continue to provide their services at minimal cost to the community through Edcoms Presentations after March 2004 and would like to be contacted to discuss how I might be able to help as a Patron or Sponsor:
4. Other way(s) that I might be willing to lend support:
