JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
ICC Iftar Registration Form
Last order should be before 1 PM for same day delivery!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Full Name:
*
Your answer
Mobile Number:
*
Your answer
Email Address:
*
Your answer
Where do you live?
*
Choose
Brossard
Greenfield Park
Saint Hubert
Saint Lambert
Longueuil
Street Number:
*
Your answer
Street Name:
*
Your answer
Apartment Number:
*
Your answer
Postal Code:
*
Your answer
Number of people at the same address:
*
1
2
3
4
5
6
7
8
9
10
Choose your delivery days:
Every Monday - March 27, April 3,10 and 17
*
Yes
No
Every Tuesday - March 28, April 4, 11 and 18
*
Yes
No
Every Wednesday - March 29, April 5, 12 and 19
*
Yes
No
Every Thursday - March 23 and 30, April 6, 13 and 20
*
Yes
No
Every Friday - March 24 and 31, April 7 and 14
*
Yes
No
Every Saturday - March 25, April 1, 8 and 15
*
Yes
No
Every Sunday - March 26, April 2, 9 and 16
*
Yes
No
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
