Registration for "Images" Series of Lectures

Please print this form, complete it, enclose a cheque or money order made out to "Canadian Friends of the Hermitage" and mail it to our office at:

Canadian Friends of the Hermitage
Ottawa Chapter - Lecture Series
280 Metcalfe Street, Suite 400
Ottawa, Ontario
Canada  K2P 1R7

Please mail the tickets to:

Name: ____________________________________________________________________

Address: _________________________________________________________________

Address: _________________________________________________________________

City: ______________________ Province: ___________ Postal Code:___________

Telephone: (___)_________ E-mail address: ________________________________