The Singles Mosaic

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:

1. I confirm that I am single, seperated, divorced or widowed.

2. Membership will cost me $50.00 for each six (6) month period (September - February or March - August inclusive).

3. Refunds for events will be issued only if your cancellation is received seven(7) days prior to the event. Non-refundable partial payments may be required at times and will be specified as such in advance.

4. The Singles' Mosaic does not take any responsibility for lost or stolen articles during any event, although we do have a lost and found.

5. To ensure a safe and enjoyable social environment for all members, the Singles' Mosaic reserves the right to rescind membership for socially unacceptable or unethical behaviour, as determined by the club management.

6. The right to cancel or reschedule events due to inclement weather or insufficient registration, with refunds to the registrants, will occur when applicable.

7. The Singles' Mosaic shall not be liable for any damages arising from personal injuries sustained by a member or guest while in attendance at any event. Members attend at their own risk and forever release and discharge the Singles' Mosaic and it's Director from all and any claims, demands, rights of action or causes of action, present or future, anticipated or anticipate arising from the loss, damage, injury or death.
				
8. Forms of payment for membership and events are Cash, Cheque, Visa, Mastercard or AMEX.

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