Please fill out the Program Registration Form and press submit and it will be e-mailed directly to us. If your browser does not support interactive forms, print off the form and fax it to us at (780) 432-0486 or mail it to us at Paralympic Sports Association, 10024-79 Avenue, Edmonton, Alberta, T6E 1R5.

Name:
Address:
City:	Province/State:
Country:
Postal Code/Zip Code:
E-mail Address:
Phone:	Home Work
	I WOULD LIKE TO REGISTER FOR THE FOLLOWING PROGRAMS:
1.	Bingos: Fees:
2.	Bingos: Fees:
3.	Bingos: Fees:
4.	Bingos: Fees:
Comments:

If you have any questions, please contact PSA at (780) 439-8687 or e-mail us at [email protected]

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