Agreement to Become an Associate Organization
of the "Improving the Quality of Canadian Seniors" Project
Name of organization: ________________________________________________
Name of representative or contact person: __________________________________
Address:
______________________________________________
______________________________________________
______________________________________________
______________________________________________
Telephone: _________________________
Fax:
_________________________
email:
_________________________
website:
________________________________________
Signature of official: _________________________________________
Position:
_________________________________________________
Date:
_________________________________________