Last Mountain Lake Drifters Registration Form

Single/Family Membership - $30.00
Mail form and Payment to:
PO Box 533 Regina Beach, SK
S0G 4C0

Name: Spouse:
Address: Postal Code:
Phone: Number in Family:
Email Address: Amount Enclosed:
For office use only:
Date Received:

*Please print this page and mail to the above address for membership.
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