Lanark Site – ConnectWell Cooks Registration form

If you need any assistance with registering, please contact Pam at 613-259-2182, ext. 2306 or Kara at 613-259-2182 ext. 2302

Mix and Mingle Fall Flavours(Required)

You may select as many as you wish to attend.

Thursday, September 21, 2023 - Souper Soups (8 spaces) remaining

Thursday, October 19, 2023 - Savour the Harvest (8 spaces) remaining

Thursday, November 16, 2023 - Reimagining an Old Favourite (8 spaces) remaining

Thursday, December 21, 2023 - Warm Winter Appetizers (8 spaces) remaining

Name(Required)

First Last

Preferred Name (if different from above)

Date of Birth

Address(Required)

Street Address Address Line 2 City Province Postal Code

Preferred(Required)

Message Allowed(Required)

Alternate

Message Allowed

Email(Required)

Please provide only email that you permit us to use to contact you.

Name(Required)

First Last

Relationship(Required)

Phone Number(Required)

As a participant of this group, I will respect the privacy and confidentiality of other individuals in the group.(Required)

Yes

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