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PHOTO GALLERY

FAMILY CENTRE

CONGRATULATORY MESSAGES

To allow your message to be handled most effectively, please answer the following questions.

(Please note that the personal information that you provide is protected under the provisions of the Privacy Act.)

* Mandatory fields.

Birthday

Birthday: (required) ^th *

Date of Birthday: (required) (yyyy/mm/dd) *

Date of Celebration: (required) (yyyy/mm/dd) *

Celebrant

Language: (required) * English French

First Name: (required) *

Last Name: (required) *

Mailing Address

Address: (required) *

City: (required) *

Province: (required) *

Postal Code: (required) *

Requested by:

First Name: (required) *

Last Name: (required) *

Address: (required) *

City: (required) *

Province: (required) *

Postal Code: (required) *

Telephone: (required) () *

Telephone (secondary): ()

Fax: ()

Email:

Delivery Instructions:

Send message to: (required) * Celebrant Requester

Please note that only Canadian citizens may receive a congratulatory certificate from the Prime Minister.

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