Non profit / non Commercial Organization:

 

 Address:  Postal Code:

 

 Contact Person:

 

 Phone Number: (R)   (B)

 

 Proposed Menu:  

 

In Park Requirements (water, power - please state how many outlets (max 2-15 amps) and for what):  

 

  Hours Of Operation (min. of 4 hours from 10:00 am to 4:00 pm

 

 Cost:$75.00

     * Please make cheques payable to The Medicine Hat and District Canada Day Society 

 

  Date: