Foundation of Quebec CAs
Registration form to win a 12-bottle case of wine

Name of the event: Draw for a 12-bottle case of wine
Date: Friday, December 10, 2010
Time: 2:00 p.m.
Location:
Ordre des comptables agréés du Québec
680 Sherbrooke Street West, 18th floor
Montreal (Quebec) H3A 2S3


IDENTIFICATION
Name:
First name:
CA: Yes       Membership No.
No
Employer:
Address:
City:
Province :
Postal code:
Telephone (office):
Telephone (home):
E-mail:

Comments:

Order
Ticket type Price Quantity
Raffle ticket $50.00

Method of payment

Cheque made payable to the Foundation of Quebec Chartered Accountants
Please return your completed form by mail to: Foundation of Quebec Chartered Accountants, 680 Sherbrooke Street West, 18th floor, Montreal, Quebec, H3A 2S3.
Credit Card
    VISA           MasterCard
Card no.:
Expiration date:
Name of the card bearer:


Signature : ___________________________________________


Please return your completed form by fax at 514 843.8375 or by mail to: Foundation of Quebec Chartered Accountants, 680 Sherbrooke Street West, 18th floor, Montreal, Quebec, H3A 2S3.

Income tax receipt: No income tax receipt is issued in the event of a draw.

Refund policy: No refund.