Burnaby Community Connections

Community Resource Guide Order Form
* required field

I would like to*

	Pick up printed copies of the guide (maximum 50 per edition)
	Have printed copies of the guide mailed to me (maximum three)

Contact Information:*

Title

(ie. Ms., Mrs., Mr., Dr., etc.)

First Name*

Last Name*

Address*

City*

Postal Code*

Phone Number.*

** Please include your e-mail address - we will not share it with anyone or send you spam. We prefer to communicate via e-mail to save time & money.

I am ordering the guide on behalf of*

Agency/
Organization Name

My Position

	Please e-mail me guide related updates and inserts
	Please e-mail me your bi-monthly newsletter, which features community news, views, and events, in addition to information of special interest to non-profits.

Due to the popularity of the guide, we strongly recommend that you phone us to make sure we
have copies of the guide in stock before you come to our offce. Our offce and mailing address is:
204-2101 Holdom avenue, Burnaby BC, V5B 0A4 and we are open weekdays from 9am - 4pm.