Member Information Collection Form

First Name:

Last Name:

Work Phone:

Home Phone:

Email Address:

Do You Speak English:

Do You Speak French:

Other Spoken Languages:

Do You Read English:

Do You Read French:

Other Written Languages:

How Would You Like to be contacted for upcoming events:

If we're bring print material to a discussion; what format would you find most Useful:



What Part Of Town Do You Live In: