fill out our registration form

Join us
An exciting evening
of wonderful wine,
food, entertainment,
auction, and awards
awaits you!
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Celebrating
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A New
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Uncorking Potential Early Registration Draw Prize
Enter by June 28, 2015
A Special Evening at the “Chucks”
This package is for two people and includes entry into Stampede Park, chuckwagon barn access and
tour, dinner and two reserved seat tickets for the evening grandstand show.
Package is good for Monday, July 6, 2015. Comfortable footwear is recommended as there will be considerable
walking in barn and race track conditions.
I would love to join you!
Enjoy an evening of fun, food and entertainment at the Uncorking Potential on September 17, 2015.
Name_____________________________________________________________________________________________________
Address___________________________________________________________________________________________________
Street
City
Province
Postal Code
Email_____________________________________________________________ Phone___________________________________
Photo Release*
Yes
No
* Photo Release: T he PGIs for Literacy and CanLearn Society request your permission to take your photograph for promotional use. The photos may be used at public presentations, in newsletters, on the internet, in
advertising and promotional materials, in newspapers and on TV.
I would like _________ tickets in the amount of $100 each for a total of $_________________
Sorry, I will not be able to attend. I am sending a donation to CanLearn in the amount of $________________
Payment
Call 403-686-9300 ext. 100 to pay by phone or email to pgi@canlearnsociety.ca
MasterCard
Visa
Cheque payable to CanLearn Society
Invoice me
Card Number_______________________________________________________ Expiry _____________
Cardholder Name___________________________________________________ Signature_______________________________
Email _______________________________________________________
Call 403-686-9300 ext. 100 or go online to www.canlearnsociety.ca/pgi
100, 1117 Macleod Trail SE Calgary, Alberta T2G 2M8