Town of Banff - Public Access

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Step 3. Account Activated

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Billing First Name:

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Address 1:

Address 2:

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Phone 1:

Phone 2:

Fax:

Email:

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Extra Information

Birthdate:

Emerg. Contact:

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Medical Information

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Allergies:		Yes		No	Epi-pen Required:		Yes		No
Other Medical Conditions:		Yes		No

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