Please complete the following if:
1. You are a resident of Stormont or Dundas County
AND
2. You are unable to drop in to one of our Centres located in Cornwall, Winchester or Chesterville.
Last Name
First Name
Middle Initial (s)
Address
City
County
Stormont
Dundas
Home Phone
E-mail
Best time to contact you by phone
Please describe the type of information that you require about our services
