Lanark Site – ConnectWell Cooks Registration form

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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.
DD slash MM slash YYYY

Telephone Number (Please provide only numbers where you permit us to call)

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

Emergency Contact



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