Manitoba Speech and Debate Association

Membership Form

School ___________________________________________________

School Address _____________________________________________

Coach ____________________________________________________

Phone Numbers : Home _________________________________

School __________________________________

Fax ____________________________________

Email (if checked regularly) __________________

Membership Fee — $200

Please send the cheque to Allison Stefanyshyn, 114 Sunny Hills Road, Winnipeg, Manitoba, R2G-2Y1. This form should be sent with it or can be faxed to John Robinson at 204-477-2429.