Current Page 1 Page 2 Preview Personal information on this form is collected under the authority of the Public Heatlh Act, Chapter P-30.1, Section 11, and the Public Health Act, Chapter P-30.1 Public Health Act Food Premises Regulations, Section 5(2) and Section 24(5) as they relate to the operation of a food premise. If you have any questions about the collection or use of this personal information, you may contact Environmental Health, at 902-368-4970 or toll free at 1-800-958-6400. Identification Are you registering as an individual or for a group? - Select -Individual RegistrationGroup Registration First Name Middle Initial Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example C1B 0X1 or 12345 Country Telephone Number For example 902-555-5555 Email Address Business/Organization Name Contact First Name Contact Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example C1B 0X1 or 12345 Country Telephone 1 For example 902-555-5555 Telephone 2 For example 902-555-5555 Fax Number For example 902-555-5555 Email Address