Application
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(To print form, right click on form and choose "Print Picture")

Complete form and mail with payment to address below.

 

RTRA MEMBERSHIP APPLICATION

 NAME:  _____________________________________________________

 TITLE:  ______________________________________________________

 PLACE OF EMPLOYMENT:  _____________________________________

 WORK ADDRESS:  ____________________________________________

 CITY/TOWN:  _______________________    POSTAL CODE:  __________

 WORK PHONE:  ______________________________________________

 FAX:  _______________________________________________________

 HOME ADDRESS:  ____________________________________________

 CITY/TOWN:  ________________________  POSTAL CODE:  __________

 HOME PHONE:  _______________________________________________

 E-MAIL:  ____________________________________________________

 COST  

$20.00 On or before the 1st meeting of the fiscal year (September).  Thereafter the cost of membership is $25.00.

Please make cheques payable to “The Regina Therapeutic Recreation Association” and forward to:

Sandra Procyk

(Tenant Services Coordinator at

Broadway Terrace)

1150 Broadway Ave.

Regina, SK

S4P 4V3