WormWatch Observer Form

First Name  
Last Name  
Organisation/Affiliation  
Mailing Address  
City/Town  
Province  
Postal Code  
*Telephone (     )
Email  
Language Preference (circle one) English     French
Age (circle one) 5-10   11-15   16-20   21-30   31-55   56 and over
10-digit Registration Number
(if not using telephone number) 		 

*Note: Your 10-digit phone number can be used as your registration number.
If you do not wish to use your telephone number, please enter a second
10-digit number in the registration number section of the Observer Form.

Please print and send to:

WormWatch
c/o Agriculture, Agri-Food Canada
Lethbridge Research Station
P.O. Box 3000
Lethbridge, AB T1J 4B1
Canada