The Centurion Club Registration Form
 
           The annual cost of membership is $10.00(Single) or $20.00(Family)
 

                                Please send form along with cheque or money order to:
 

                                                     Garrie Lambert/The Centurion Club

                                                      49 Buckwheat Lane

                                                      Cumberland Bay, NB. E4A 3K4
 
 

Name:

 Partner: 

Street:

        Apt:    

City:

State/Prov:

Country:

Zip/Postal Code:

Phone:

E-mail:

                                                                     Method Of Payment
 

                                                      Check                        Money Order