Registration for Choices 2012
Admission:$ 55.00
Quantity1
Table Captain
First Name
Last Name
First Name
Last Name
First Name
Last Name
Participant
Salutation
First Name
Last Name
Maiden Name (if different than last name)
Birthday
/ /
Is this the first time you participate at Choices?
Yes No 
Preferred Language
English French 
E-mail
Home Phone
Cell Phone
Address
City
Province
Postal Code
Credit Card Information
Credit Card Number
Please do not enter spaces
Cardholder's Name
(As it appears on your Credit Card)
Card Type
Expiry Date
/
Total $ 55.00
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Federation CJA is a registered charitable organization pursuant to the Canadian Income Tax Act - Registration number: 106702251RR0001.
Federation CJA is a 501c(3) non-profit Community Organization - 98-018 3709.
All donations to Federation CJA are tax-deductible in full.