First Name:   Last Name:    Email: 

Street Address:     City:     Postal or Zip:  

Mobile or Day Phone:    

Amount in party including you:  

Your first and last name you would like on name tag: 

First and Last Name of your guest if applicable:   

Guest name tag first and last name if applicable: 

If you wish to pay via credit card,  fill in the credit card numbers here:    Expiry: 

Amount debited to your card: 

Any comments you have:   

Optional: 

Would you like to assist with organizing ?

Note Credit card purchases will show up as "Wave Media Inc." on your statement. 

You may also fax your credit card details in to 1 866 793 0952 (toll free) or call 780 518 5672 for a live person (Kevin) or 780 539 0623 for a confidential voice mail.

Or mail a check payable to "Michelle Moffatt"

Michelle Moffatt
828-10th street
Brandon MB R7A 4H1