{"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\/fr\/evenements\/inscription-momentum-cheque\/","title":{"rendered":"Inscription Momentum Ch\u00e8que"},"content":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row&#8221; css=&#8221;.vc_custom_1660943054074{margin-top: 150px !important;background-color: #3b3b45 !important;}&#8221;][vc_column][vc_single_image image=&#8221;2800&#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>FORMULAIRE DE PARTICIPATION - COCKTAIL MOMENTUM 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-2809 size-full\" src=\"https:\/\/jaquebec.org\/wp-content\/uploads\/2019\/10\/pastille-momentum2020.png\" alt=\"\" width=\"280\" height=\"280\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><strong>Pour toute question,<\/strong><br \/>\ncontactez Caroline Schnoering<br \/>\nau 514 285-8944 poste 100.<\/p>\n<p><strong>Merci de votre participation!<\/strong><\/p>\n<p><span style=\"font-size: 11px;\">Un re\u00e7u pour fins d\u2019imp\u00f4t sera envoy\u00e9 sur demande pour les dons et la portion don du billet. Num\u00e9ro d\u2019organisme de charit\u00e9 : 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-f1994-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"1994\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/fr\/wp-json\/wp\/v2\/pages\/2840#wpcf7-f1994-o1\" 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=\"1994\" \/><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-f1994-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<h3>Vos coordonn\u00e9es\n<\/h3>\n<div class=\"row\">\n\t<div class=\"col-md-4\">\n\t\t<p><label>Pr\u00e9nom (obligatoire)<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>Nom (obligatoire)<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=\"Madame\" \/><span class=\"wpcf7-list-item-label\">Madame<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"madame-monsieur\" value=\"Monsieur\" \/><span class=\"wpcf7-list-item-label\">Monsieur<\/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>Titre<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>Entreprise\/organisme<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>Adresse (obligatoire)<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>Ville (obligatoire)<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>Code postal (obligatoire)<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 (obligatoire)<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>Pays (obligatoire)<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>T\u00e9l\u00e9phone (obligatoire)<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>Courriel (obligatoire)<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>Nombre de billet(s) (200 $ chaque)<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>Nom(s) du\/des 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>Je souhaite faire un don <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=\"Logo projet\u00e9 sur \u00e9cran - 250 $\" \/><span class=\"wpcf7-list-item-label\">Logo projet\u00e9 sur \u00e9cran - 250 $<\/span><\/span><\/span><\/span><br \/>\n<hr \/>\n<\/p>\n<h3>Programme de partenariat\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=\"MENTOR PRINCIPAL (inclut 8 billets) - 5 000 $\" \/><span class=\"wpcf7-list-item-label\">MENTOR PRINCIPAL (inclut 8 billets) - 5 000 $<\/span><\/span><\/span><\/span>\n<\/p>\n<ul>\n\t<li>\n\t\t<p>Inclut 8 billets d'entr\u00e9e,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>affiche de votre entreprise sur la sc\u00e8ne principale (fournie par vous),\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>logo grand format projet\u00e9 sur \u00e9cran,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>mention au micro,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>prise de parole lors de l'\u00e9v\u00e9nement,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>mention dans les communications de JA Qu\u00e9bec.\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=\"MENTOR IMPORTANT (inclut 4 billets) - 3 000 $\" \/><span class=\"wpcf7-list-item-label\">MENTOR IMPORTANT (inclut 4 billets) - 3 000 $<\/span><\/span><\/span><\/span>\n<\/p>\n<ul>\n\t<li>\n\t\t<p>Inclut 4 billets d'entr\u00e9e,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>affiche de votre entreprise sur la sc\u00e8ne des artistes (fournie par vous),\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>logo grand format projet\u00e9 sur \u00e9cran,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>mention au micro.\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=\"MENTOR AMI (inclut 2 billets) - 1 500 $\" \/><span class=\"wpcf7-list-item-label\">MENTOR AMI (inclut 2 billets) - 1 500 $<\/span><\/span><\/span><\/span>\n<\/p>\n<ul>\n\t<li>\n\t\t<p>Inclut 2 billets d'entr\u00e9e,\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>affiche de votre entreprise dans la salle (fournie par vous),\n\t\t<\/p>\n\t<\/li>\n\t<li>\n\t\t<p>logo grand format projet\u00e9 sur \u00e9cran.\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>Nom du solliciteur ou comment avez-vous entendu parler de nous?<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>Je souhaite recevoir :\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=\"Facture par courriel\" \/><span class=\"wpcf7-list-item-label\">Facture par courriel<\/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=\"Re\u00e7u de charit\u00e9 en mon nom personnel\" \/><span class=\"wpcf7-list-item-label\">Re\u00e7u de charit\u00e9 en mon nom personnel<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"recu-perso-ets\" value=\"Re\u00e7u de charit\u00e9 au nom de mon entreprise\" \/><span class=\"wpcf7-list-item-label\">Re\u00e7u de charit\u00e9 au nom de mon entreprise<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"recu-perso-ets\" value=\"Pas de re\u00e7u de charit\u00e9\" \/><span class=\"wpcf7-list-item-label\">Pas de re\u00e7u de charit\u00e9<\/span><\/label><\/span><\/span><\/span><br \/>\nL'adresse indiqu\u00e9e plus haut doit correspondre \u00e0 votre choix de re\u00e7u (personnel ou entreprise). Aucun re\u00e7u d'imp\u00f4t ne sera envoy\u00e9 pour les programmes de partenariat ou le logo sur \u00e9cran.\n<\/p>\n<p><strong>Sur r\u00e9ception de votre formulaire, nous vous ferons parvenir une confirmation par courriel du montant total \u00e0 payer par ch\u00e8que. D\u00e8s r\u00e9ception du paiement, les billets d'entr\u00e9e vous seront envoy\u00e9s par courriel. Aucun remboursement.<\/strong>\n<\/p>\n<div align=\"center\">\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyez votre participation \u00e0 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_1572277614508{margin-bottom: 25px !important;}&#8221;]<strong>Veuillez faire parvenir votre ch\u00e8que par la poste \u00e0 l&#8217;adresse suivante :<\/strong><br \/>\nJA Qu\u00e9bec<br \/>\n300, rue du Saint-Sacrement, bur. 208<br \/>\nMontr\u00e9al (Qu\u00e9bec) H2Y 1X4<\/p>\n<p><strong>Merci de votre 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_1660943054074{margin-top: 150px !important;background-color: #3b3b45 !important;}&#8221;][vc_column][vc_single_image image=&#8221;2800&#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; Pour toute question, contactez Caroline Schnoering au 514 285-8944 poste 100. Merci de votre participation! Un re\u00e7u pour fins d\u2019imp\u00f4t sera envoy\u00e9 sur demande pour les dons et la portion don du billet. Num\u00e9ro d\u2019organisme de charit\u00e9 [&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\/fr\/wp-json\/wp\/v2\/pages\/2840","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jaquebec.org\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/jaquebec.org\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/jaquebec.org\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/jaquebec.org\/fr\/wp-json\/wp\/v2\/comments?post=2840"}],"version-history":[{"count":21,"href":"https:\/\/jaquebec.org\/fr\/wp-json\/wp\/v2\/pages\/2840\/revisions"}],"predecessor-version":[{"id":7808,"href":"https:\/\/jaquebec.org\/fr\/wp-json\/wp\/v2\/pages\/2840\/revisions\/7808"}],"up":[{"embeddable":true,"href":"https:\/\/jaquebec.org\/fr\/wp-json\/wp\/v2\/pages\/816"}],"wp:attachment":[{"href":"https:\/\/jaquebec.org\/fr\/wp-json\/wp\/v2\/media?parent=2840"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}