Momentum Participation Cheque

REGISTRATION FORM - MOMENTUM COCKTAIL 2020

For any questions,
contact Caroline Schnoering
at 514 285-8944 ext. 100.

Thank you for your participation!

A receipt will be sent by request for donations and the donation portion of the ticket. Charitable organisation number: 107618217RR0001

Your contact information

Given Name (mandatory)

Surname (mandatory)

Mrs.Mr.

Title

Company/Organisation

Address (mandatory)

City (mandatory)

Postal Code (mandatory)

Province (mandatory)

Country (mandatory)

Phone (mandatory)

Email (mandatory)

Participation

Quantity of ticket(s) ($200 each)

Name(s) of the participant(s)

I would like to make a donation

On-screen logo - $250

Partnership Program

LEAD MENTOR (Includes 8 tickets) - $5,000

Includes 8 tickets,
Business display - Main Stage (supplied by you),
On-screen logo projection large display,
Mention over microphone,
Speaker at the event,
Mention in JA Quebec's communications.

MAJOR MENTOR (Includes 4 tickets) - $3,000

Includes 4 tickets,
Business display - Performers Stage (supplied by you),
On-screen logo projection large display,
Mention over microphone.

SUPPORTING MENTOR (Includes 2 tickets) - $1,500

Includes 2 tickets,
Business display - Event Room (supplied by you),
On-screen logo projection large display.

Administration

Solicitor's name or how did you hear about us?

I would like to receive :

Invoice by email

Tax receipt in my personal nameTax receipt on behalf of my companyNo tax receipt

The address indicated above must match your choice of receipt (personal or company). No receipt will be provided for the Partnership Program or the on-screen logo.

Upon receipt of your form, we will send you by email the total amount to be paid by check. We will send you your tickets by email upon receipt of your cheque. No refund.

Please send your payment by mail to the following address:
JA Quebec
300, Saint-Sacrement Street, #208
Montreal (Quebec) H2Y 1X4

Thank you for your participation!