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Please attach your remittance to this form
Mail it in the envelope enclosed to:

Esbiad ’67
777 West 26th Ave.
Vancouver, BC
V5Z 2E7

MAKE YOUR CHEQUE OR MONEY ORDER PAYABLE TO ESBIAD ‘67

(Canadian funds only please – no foreign cheques)

Name (Maiden or Birth name)

My Personal Profile Update (for the website):

Current Name (if different)
Phone:
(Home)
(Work)
Mailing Address:

I'm planning to attend : Yes No:
I will need tickets additional tickets at $40 each.
Email:
Please priint names of additional guests

(Unfortunately, once you have paid for this incredible evening, we will not be able to facilitate any refunds as your money will have been spent).


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