{"id":2840,"date":"2019-01-08T17:15:04","date_gmt":"2019-01-08T22:15:04","guid":{"rendered":"https:\/\/jaquebec.com\/?page_id=2840"},"modified":"2022-08-19T17:04:28","modified_gmt":"2022-08-19T21:04:28","slug":"inscription-momentum-cheque","status":"publish","type":"page","link":"https:\/\/jaquebec.org\/en\/evenements\/inscription-momentum-cheque\/","title":{"rendered":"Momentum Participation Cheque"},"content":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row&#8221; css=&#8221;.vc_custom_1660943065464{margin-top: 150px !important;background-color: #3b3b45 !important;}&#8221;][vc_column][vc_single_image image=&#8221;2883&#8243; img_size=&#8221;full&#8221; alignment=&#8221;center&#8221;][\/vc_column][\/vc_row][vc_row][vc_column]<div class='headline with-icon text-center '><i class='berlin-icon-male'><\/i><h3>REGISTRATION FORM - MOMENTUM COCKTAIL 2020<\/h3><\/div>[\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1524511132185{margin-top: 25px !important;}&#8221;][vc_column width=&#8221;1\/4&#8243; css=&#8221;.vc_custom_1546982055494{background-color: #ededed !important;}&#8221;][vc_column_text]<img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-2880 size-full\" src=\"https:\/\/jaquebec.org\/wp-content\/uploads\/2019\/10\/pastille-momentum2020-EN.png\" alt=\"\" width=\"280\" height=\"280\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><strong>For any questions,<\/strong><br \/>\ncontact Caroline Schnoering<br \/>\nat 514 285-8944 ext. 100.<\/p>\n<p><strong>Thank you for your participation!<\/strong><\/p>\n<p><span style=\"font-size: 11px;\">A receipt will be sent by request for donations and the donation portion of the ticket. Charitable organisation number: 107618217RR0001<\/span>[\/vc_column_text][vc_empty_space][\/vc_column][vc_column width=&#8221;3\/4&#8243; css=&#8221;.vc_custom_1546982147063{padding-left: 60px !important;}&#8221;]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2023-o2\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"2023\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/2840#wpcf7-f2023-o2\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"2023\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f2023-o2\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<h3>Your contact information\n<\/h3>\n<div class=\"row\">\n\t<div class=\"col-md-4\">\n\t\t<p><label>Given Name (mandatory)<span class=\"wpcf7-form-control-wrap\" data-name=\"prenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"prenom\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-md-4\">\n\t\t<p><label>Surname (mandatory)<span class=\"wpcf7-form-control-wrap\" data-name=\"nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nom\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-md-4\">\n\t\t<p><label>&nbsp;<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"madame-monsieur\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"madame-monsieur\" value=\"Mrs.\" \/><span class=\"wpcf7-list-item-label\">Mrs.<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"madame-monsieur\" value=\"Mr.\" \/><span class=\"wpcf7-list-item-label\">Mr.<\/span><\/label><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"row\">\n\t<div class=\"col-md-4\">\n\t\t<p><label>Title<span class=\"wpcf7-form-control-wrap\" data-name=\"titre\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"titre\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-md-4\">\n\t\t<p><label>Company\/Organisation<span class=\"wpcf7-form-control-wrap\" data-name=\"entreprise-organisme\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"entreprise-organisme\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"row\">\n\t<div class=\"col-md-8\">\n\t\t<p><label>Address (mandatory)<span class=\"wpcf7-form-control-wrap\" data-name=\"adresse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adresse\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"row\">\n\t<div class=\"col-md-4\">\n\t\t<p><label>City (mandatory)<span class=\"wpcf7-form-control-wrap\" data-name=\"ville\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ville\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-md-4\">\n\t\t<p><label>Postal Code (mandatory)<span class=\"wpcf7-form-control-wrap\" data-name=\"code-postal\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"code-postal\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"row\">\n\t<div class=\"col-md-4\">\n\t\t<p><label>Province (mandatory)<span class=\"wpcf7-form-control-wrap\" data-name=\"province\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"province\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-md-4\">\n\t\t<p><label>Country (mandatory)<span class=\"wpcf7-form-control-wrap\" data-name=\"pays\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"pays\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"row\">\n\t<div class=\"col-md-4\">\n\t\t<p><label>Phone (mandatory)<span class=\"wpcf7-form-control-wrap\" data-name=\"telephone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"telephone\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-md-4\">\n\t\t<p><label>Email (mandatory)<span class=\"wpcf7-form-control-wrap\" data-name=\"courriel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"courriel\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<hr \/>\n<h3>Participation\n<\/h3>\n<div class=\"row\">\n\t<div class=\"col-md-4\">\n\t\t<p><label>Quantity of ticket(s) ($200 each)<span class=\"wpcf7-form-control-wrap\" data-name=\"billet\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"billet\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-md-4\">\n\t\t<p><label>Name(s) of the participant(s)<span class=\"wpcf7-form-control-wrap\" data-name=\"participant\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"participant\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"row\">\n\t<div class=\"col-md-4\">\n\t\t<p><label>I would like to make a donation <span class=\"wpcf7-form-control-wrap\" data-name=\"don\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"$\" type=\"text\" name=\"don\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-md-4\">\n\t<\/div>\n<\/div>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"logo-prejete\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"logo-prejete[]\" value=\"On-screen logo - $250\" \/><span class=\"wpcf7-list-item-label\">On-screen logo - $250<\/span><\/span><\/span><\/span><br \/>\n<hr \/>\n<\/p>\n<h3>Partnership Program\n<\/h3>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"mentor-principal\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"mentor-principal[]\" value=\"LEAD MENTOR (Includes 8 tickets) - $5,000\" \/><span class=\"wpcf7-list-item-label\">LEAD MENTOR (Includes 8 tickets) - $5,000<\/span><\/span><\/span><\/span>\n<\/p>\n<ul>\n\t<li>\n\t\t<p>Includes 8 tickets,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>Business display - Main Stage (supplied by you),\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>On-screen logo projection large display,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>Mention over microphone,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>Speaker at the event,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>Mention in JA Quebec's communications.\n\t\t<\/p>\n\t<\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"mentor-important\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"mentor-important[]\" value=\"MAJOR MENTOR (Includes 4 tickets) - $3,000\" \/><span class=\"wpcf7-list-item-label\">MAJOR MENTOR (Includes 4 tickets) - $3,000<\/span><\/span><\/span><\/span>\n<\/p>\n<ul>\n\t<li>\n\t\t<p>Includes 4 tickets,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>Business display - Performers Stage (supplied by you),\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>On-screen logo projection large display,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>Mention over microphone.\n\t\t<\/p>\n\t<\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"mentor-ami\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"mentor-ami[]\" value=\"SUPPORTING MENTOR (Includes 2 tickets) - $1,500\" \/><span class=\"wpcf7-list-item-label\">SUPPORTING MENTOR (Includes 2 tickets) - $1,500<\/span><\/span><\/span><\/span>\n<\/p>\n<ul>\n\t<li>\n\t\t<p>Includes 2 tickets,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>Business display - Event Room (supplied by you),\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>On-screen logo projection large display.\n\t\t<\/p>\n\t<\/li>\n<\/ul>\n<hr \/>\n<h3>Administration\n<\/h3>\n<div class=\"row\">\n\t<div class=\"col-md-6\">\n\t\t<p><label>Solicitor's name or how did you hear about us?<span class=\"wpcf7-form-control-wrap\" data-name=\"nom-solliciteur\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nom-solliciteur\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-md-6\">\n\t<\/div>\n<\/div>\n<p>I would like to receive :\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"facture\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><input type=\"checkbox\" name=\"facture[]\" value=\"Invoice by email\" \/><span class=\"wpcf7-list-item-label\">Invoice by email<\/span><\/span><\/span><\/span>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"recu-perso-ets\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"recu-perso-ets\" value=\"Tax receipt in my personal name\" \/><span class=\"wpcf7-list-item-label\">Tax receipt in my personal name<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"recu-perso-ets\" value=\"Tax receipt on behalf of my company\" \/><span class=\"wpcf7-list-item-label\">Tax receipt on behalf of my company<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"recu-perso-ets\" value=\"No tax receipt\" \/><span class=\"wpcf7-list-item-label\">No tax receipt<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p>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.\n<\/p>\n<p><strong>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.<\/strong>\n<\/p>\n<div align=\"center\">\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit your registration to Momentum\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[vc_column_text css=&#8221;.vc_custom_1572277903922{margin-bottom: 25px !important;}&#8221;]<strong>Please send your payment by mail to the following address:<\/strong><br \/>\nJA Quebec<br \/>\n300, Saint-Sacrement Street, #208<br \/>\nMontreal (Quebec) H2Y 1X4<\/p>\n<p><strong>Thank you for your participation!<\/strong>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>","protected":false},"excerpt":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row&#8221; css=&#8221;.vc_custom_1660943065464{margin-top: 150px !important;background-color: #3b3b45 !important;}&#8221;][vc_column][vc_single_image image=&#8221;2883&#8243; img_size=&#8221;full&#8221; alignment=&#8221;center&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1524511132185{margin-top: 25px !important;}&#8221;][vc_column width=&#8221;1\/4&#8243; css=&#8221;.vc_custom_1546982055494{background-color: #ededed !important;}&#8221;][vc_column_text] &nbsp; 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[\/vc_column_text][vc_empty_space][\/vc_column][vc_column width=&#8221;3\/4&#8243; [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":816,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-2840","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/jaquebec.org\/en\/wp-json\/wp\/v2\/pages\/2840","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jaquebec.org\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/jaquebec.org\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/jaquebec.org\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/jaquebec.org\/en\/wp-json\/wp\/v2\/comments?post=2840"}],"version-history":[{"count":21,"href":"https:\/\/jaquebec.org\/en\/wp-json\/wp\/v2\/pages\/2840\/revisions"}],"predecessor-version":[{"id":7808,"href":"https:\/\/jaquebec.org\/en\/wp-json\/wp\/v2\/pages\/2840\/revisions\/7808"}],"up":[{"embeddable":true,"href":"https:\/\/jaquebec.org\/en\/wp-json\/wp\/v2\/pages\/816"}],"wp:attachment":[{"href":"https:\/\/jaquebec.org\/en\/wp-json\/wp\/v2\/media?parent=2840"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}