The Duke of Edinburgh’s Award

If New Group Check Here __________ Young Canadians Challenge

The Duke of Edinburgh’s Award Alberta, NWT & Nunavut
If Independent Check Here __________ Young Canadians Challenge Division
111-4515 Bow Trail SW
Registration Form Calgary, AB T3C 2G3
Phone (403) 237-7476
Please Print Toll Free 1-800-668-3853
Name of Group or Individual: ____________________________________________________________ Fax (403) 269-7826
dukeabnt@telusplanet.net
D of E Leader or Mentor’s Name: ___________________________________________________________

Group Mailing Address: ________________________________________ City : ______________________ Postal Code:_____________________

Phone Number (Home) (__________) _________________ Work Number: (___________) ______________ Cell: (________) _________________

Email Address: ____________________________________________________ FILE NUMBER (office use only) ______________________________

Participants Name Address (Area Code) Email Sex Birthday Award Entry Date
Last/First Apt, Street, City, Postal Code Phone (M/F) (mm/dd/yy) Level (mm/dd/yy)
(B/S/G)

Number of Registrations __________________@$20.00 = ___________

Number of Leaders manuals _______________@$10.00 = ___________ Total payment enclosed ____________
The Duke of Edinburgh’s Award respects your privacy. We protect your personal information and adhere to all legislative requirements with respect to protecting privacy. We do not rent, sell or trade our mailing lists. Your
name and address and other information you provide will be used to deliver services and to keep you informed and up to date on activities of the DOE, including programs, services, special events, funding needs, opportunities
to volunteer or to give. If at any time you wish to receive less mail or wish to be removed from any of our communications please simply contact us by phone (403) 237-7476 or via email dukeabnt@telusplanet.net and we will
gladly accommodate your request.