Amount enclosed (please circle one) : -------- $25 for one year -------- $50 for two years

 

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Youth's first and last name ---------------------------------------------------------------------------------- Birth date

 

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Youth's first and last name ---------------------------------------------------------------------------------- Birth date

 

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Youth's first and last name ----------------------------------------------------------------------------------  Birth date

 

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Youth's first and last name ----------------------------------------------------------------------------------- Birth date

 

 

 

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Parent or Guardian (1) ----------------------------------------------------------------------------------  Parent or Guardian (2)

 

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Telephone number ----------------------------------------------------------------------------------  e-mail

 

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Mailing address ------------------------------------------------------------ Town ----------------------------- Province ----------------- Postal Code

 

 

 

Please  comment on YNC -- tell us what you like, what you want more of, and any changes you suggest -- we need your feedback.

 

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Is this a gift? ________________

 

If yes, please tell us the donor's name so we can enclose a gift card. _____________________________________________