Please print and return this form before Tuesday, May 21, 2013

Lac Boivin and Park Yamaska

Name(s): _______________________________________________________    

Tel.:    _______________________________________________________

Address: _______________________________________________________

         _______________________________________________________

         _______________________________________________________

Members: ______ x  $55  =   $ ________         Non–members: ______ x  $60   =   $________

Total: $ ________

Do you need a pick-up at Place Portobello?__________


Hold Harmless Clause:

I, the undersigned, hold the Zoological Society of Montreal harmless from responsibility to life, limb, or property resulting from any accident, regardless of whatever may be the cause, on the above advertised event.

Signature: ___________________________________

Date: ___________________________________


I enclose a cheque for $________, payable to the Zoological Society of Montreal.

Mail to:
Zoological Society of Montreal,
1117 Ste-Catherine Street West, Suite 525
Montreal, QC
H3B 1H9

Tel.: (514) 845–8317


Back to the Field Trip Page         Back to the Zoological Society Home Page