CSSA @ UWO Shopping Partners

 
Please complete the following form, so we can help you to find a partner. You will receive a confirmation by email once your information has been processed. All information collected by this form will be kept confidential, and no private information will be release to the third party.  
If you encounter any difficulties with the registration procedure, please contact us by email.
Note: * - Indicates a Required Field. 
Partner Type   I can offer a ride I need a ride * 
Name *
Home Phone *
E-mail *
Address *
Prefer Payment  $*
# of seats needed or available * 
Favorite Grocery Store  Food basic Asia Market 
Price Chopper A & P Loblaw No preference 
Others:
Preferred Shopping Time DayTime  
Times of shopping / month
PLEASE PRESS THE SUBMIT FORM BUTTON ONLY ONCE.
It may take up to 1-2 min to process the form, depending on your connection speed and how busy our server is processing registrations. Please be patient.