Member Registration










Membership Information
Please enter required * information.

* Type

New Membership   Renewal

* First Name
* Last Name

* Address

* City

* Province

* Postal Code

* Home Phone

Work Phone

FAX

Email Address

Occupation

Food Allergies ?

* Age Group

Under 40  Over 40


Event Survey

Add variety to your social life ! Try something new ! View the following list of terrific events, tick off your interests. By answering this survey, you are NOT committing yourself to attend. We will notify you to confirm your interest and book your place approximately one week before the event, or you may phone us or register directly on-line. These events are outlined in the brochure and on the website events page.

Games Night Dine & Date
Psychic Night Dances
Orientation Brunch Dance Lessons
Casino Niagara Trip Art Gallery Tour
Port Dalhousie Theatre Frankenmuth, Mich Shopping
New York City Trip House Parties
Skating Golfing
Race Track Trip Falcon Lodge Weekend
Lighthouse Theatre Pig and Beef Roast
Toronto Harbour Boat Cruise Habitat For Humanity

Event Suggestions
Got any ideas for future events? Let us know!
Please try to provide us with as much information as possible. (eg. places, addresses, phone numbers?)

VIP Club
I would be interested in being on the following committee(s):
Ambassador Assistant

How would you like to pay for your Membership?
  I will send a cheque.
  Please call me for my Credit Card number.
  I will pay at the next Networking event.

Membership Conditions
Please read the following conditions of registration carefully:

I have read the above and agree to abide by these conditions.*

The Singles Mosaic
Phone: (905) 333-4498 or (888) 334-4449
Events Hotline: (905) 333-9149 | Fax: (905) 333-4992
E-mail: singles.mosaic@cogeco.ca

Paradiso
Restaurant

10% Disc. for
member & 1 guest
on lunch or dinner
entree (All week)
(905) 639-1176
Visit Website
Sonzi
15% Disc. for
member & 1 guest
Sun - Thurs in
dining room
(Food Only)
(905) 632-6682
Visit Website
Thyme
Restaurant

10% Disc. for
member & 1 guest
on lunch or dinner
entree (All week)
(905) 815-8638
Visit Website
Landmark
Steak House

25% Disc. for
member & 1 guest
(Food Only -
All week)
(905) 634-6275
Visit Website
Ristorante
Julia

Buy 1 Appetizer
Get 1 Free
(905) 844-7401
Visit Website
Siam Dish
10% Disc. for
member & 1 guest
(Food Only -
All Week)
(905) 632-2525
Visit Website
Water Street
Cooker

Two for one
entrees for
member & 1 guest
Tues - Fri
(905) 634-2084
Visit Website
Magnum
Promotions

All your promotional
needs FREE set-up
& 10% Discount
(For All 2008)
(905) 765-8775
Visit Website
Great
Glasses

$100 off any
3 for one order
(866) GR8-4341
Visit Website
Liz's Weight
Loss Program

Special pricing
Goal Settings &
Personal Programs
(905) 635-1960
Visit Website