Fields in red are required fields and MUST be completed.

FIRST NAME:	LAST NAME:
ADDRESS:	CITY:
PROVINCE:	POSTAL CODE:
HOME PHONE:	WORK PHONE:
CELL PHONE:	BIRTHDAY:
eMAIL:	GENDER: ==SELECT== Female Male
CONFIDENTIALITY AGREEMENT I authorize the Victoria Pride Society to collect and maintain the above personal information. This information will be used to advise me of crew schedules, training, and future VPS events. My name and address will be retained on file. My information will be used for these purposes only and shall be held in strict confidence.