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This is not an interactive form as yet. Print this form out, fill it in and mail it to us to register for your programs.
Name________________________________Birthdate_____________________
Address______________________________Apt.____ Postal Code___________
Home Phone________________ Work______________ Ext.______
Emergency: _________________
Method of Payment:
Cheque____ (Payable to “Halifax Regional Municipality”) No post-dates please!
Visa____Mastercard_____American Express _____ Money Order_____
Card #_____________________Expiry Date___________
Name on Card________________________Signature_______________________
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