Name:
  
Address:
  
City & Province:
  
Postal Code:
  
Telephone:
  
Fax:
  
E-Mail:
  
SEND YOUR CHEQUE
for $17.00 to:
Inter-Provincial Bird Association
c/o Lisa Blais
P.O. Box 2945
Brownsburg-Chatham, Qc
J8G 2T9
For further information, write to:
info@expolachute.com
YES - I would like my contact information to appear in the BREEDERS
DIRECTORY section on the I.P.B.A. website, as it published in the yearly
published Breeders' Directory.  
(Sign below please)
_____________________________________________________
Signature
NO -I do not want my contact information to appear in the BREEDERS
DIRECTORY section on the I.P.B.A. website, as it is published yearly in the
I.P.B.A. Breeders' Directory.