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Print this form out, and either drop off or mail in with your check: Business Name: _________________________________________________ Contact Name: _________________________________________________ Phone Number: _________________________________________________ Email Address: _________________________________________________ Website Address: _________________________________________________ Type of Listing (check applicable):
LISTING FEE: $70.00/listing
(Metchosin.Org only) TERM OF LISTING:one year TOTAL PAYMENT: ________ ( PLEASE CIRCLE OPTION: SEND RECEIPT BY: EMAIL / POST ) Please
make cheques payable to: PAX MEDIA INC. |