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Get Canada LIC/GAM 5471 2007

D of any changes to the elected executive. Please provide information for all bona fide executive members and positions authorized to sign documents forwarded to AGLC. Complete this form and return to the AGLC as follows: Alberta Gaming and Liquor Commission Regulatory Division, 50 Corriveau Avenue, St. Albert, Alberta T8N 3T5 Fax (780) 447-8911 or (780) 447-8912, email: gaming.licensing@aglc.gov.ab.ca Group Name and Mailing Address: AGLC ID Number: Date Completed: Email: Website: PRESIDENT.

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