Person Ordering Telephone Number E-mail Address Select the medallion you would like to order:1 Year+Card $21+HST5 Year $26+HST10 Year $29+HST15 Year $29+HST20 Year $29+HST25 Year $29+HST30 Year $29+HST35 Year $29+HST40 Year $29+HST45 Year $29+HST50 Year $29+HSTBRONZE (off year) $21+HSTSpecial Colour $29+HST
Fill in what you would like on your medallion order below (a letter, number, period, space or comma is a character):
Name & Last Initial - Maximum 14 Characters
Dry Date
Group Name - Maximum 18 Character
Slogan or Saying - Maximum 17 Characters
Date Medallion Required
How would you like to receive the medallion? Pickup at Intergroup OfficeCanada Post (Regular Mail)Canada Post *With Tracking
Address Information
Street Address Line 1
Apartment/Unit
City or Town
Province or Territory—Please choose an option—AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon
Postal Code
Additional Information
