2. 
4. Want to receive updates on programs, events, discounts and stay in the loop? Be in the number!
6. First Name*
8. Last Name*
10. Address*
12. Zip Code*
14. Ward*

    Select your ward.

    1. Ward 1
    2. Ward 2
    3. Ward 3
    4. Ward 4
    5. Ward 5
    6. Ward 6
    7. Ward 7
    8. Ward 8
    9. Ward 9
    10. Ward 10
16. Home Phone
18. Mobile Phone
20. Email Address
22. Birthday
    Birthday

    To be included in the birthday club

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24. 1. Receive an email copy of this form.
25. Email address

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26. Submit

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