First Name
Last Name
Telephone
Email
Please indicate the region closest to you.---North West Region (Longlac, Hearst, Mattice)North Central Region (Kapuskasing, Opasatika, Moonbeam, Fauquier, Val Rita, Smooth Rock Falls)North East Region (Timmins, Iroquois Falls, Val Gagné)Nipissing West Region (Verner, Warren, Noëlville, Alban, St. Charles, Argyle, Markstay)Nipissing Central Region (Sturgeon Falls, Field)Nipissing East Region (North Bay, Mattawa, Bonfield, West Ferris)
Take a picture of yourself with the participation sheet. Please submit your photo in JPEG or PNG format.
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