Registration Form & Banquet Reservation







REGISTRATION:

$20 payable to Haiku Canada; before April 15, 2005 and

$25 after April 15.



BANQUET:

Dinner - Saturday, May 21, 2004 $25 payable to Haiku Canada





Early Registration ($20)

Late Registration ($25)

Banquet ($25)

TOTAL $



* * * PLEASE PRINT CLEARLY * * *





Name_________________________________

Address______________________________________

City __________ Prov. _______Postal code __________

Phone (___)_______________

Email _____________________


Send cheque or money order payable to Haiku Canada and mail it with this form to:

DeVar Dahl
Po Box 81
Magrath, Alberta T0K 1J0