50th anniversary burgee Brockville CPS Burgee Order Form

Please place my order for:

Brockville Power and Sail Squadron
50th Anniversary Gold Burgee

____ [insert number] @ $30.00 each - Total: $________

and mail my order to:

Name: _________________________________________________
Street Address: _________________________________________________
Box Number: _________________________________________________
Town/City: _________________________________________________
Postal Code: _________________________________________________
Please print, then complete and mail this order form with your cheque payable to:
The Brockville Power and Sail Squadron

Mail to:

Brian Prince
137 King St. East
Brockville, ON
K6V 1C1

Brockville Squadron
-updated: 2011-12-20