2012 Patriot Days - Sackville, NS

*** NOTE: ALL FIELDS ARE REQUIRED ***

Name of Group

Contact Person	First Name: Last Name:

Mailing Address	Street: City/Town: Province: Postal Code:

Phone Number

Email Address

Detailed Description of Entry	(please provide as much detail as possible for best publicity)

Music	Does Entry Play Music? Yes No	Does Entry Make Excessive Noise? Yes No

Approximate Length of Total Entry

For further information please contact Paul Russell at 830-5043