Salsa Night Registration Form

Join Us on Friday, November 22, 2024 for an evening of Salsa!

This fun night will take place at Kawartha Country Wines (2452 Peterborough County Rd 36, Buckhorn), and includes:

A 45 minute Salsa lesson - No partner required

Welcome Glass of Cider

5 Wine samples and Tour

Dessert wine sample paired with Dessert

The cost to register is $75, with a $26 tax receipt issued following the event.

This fundraising event will support Community Care in Lakefield.

Once this Jotform has been completed, you will be contacted by Community Care Peterborough for payment.

Payment can be made by credit card, etransfer, cash, or cheque.

Thank you for your support!
Name (First and Last)*
Address (for tax receipt purposes)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number*
Contact Email*
Name (2nd attendee, if applicable)
Address (for tax receipt purposes)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number
Contact Email
Name (3rd attendee, if applicable)
Address (for tax receipt purposes)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number
Contact Email
Name (4th attendee, if applicable)
Address (for tax receipt purposes)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone Number
Contact Email
Community Care in Lakefield will be in touch for payment details.

Thank you very much!
Should be Empty: