PLEASE FILL IN THE FORM AND SEND IT TO:
BY EMAIL: [email protected]
BY FAX: 514 866-1838
BY POST: Women’s Y Foundation, 1355 René-Lévesque Blvd. West, Montreal, Quebec, H3G 1T3
Fondation.Ydesfemmesmtl.org
CONTACTS DETAILS
FULL NAME: …………………………………………………………………… ………… TITLE: ………………………………………………………………………….
NAME OF COMPANY (if apply): …………………………………………………………...………………………………………………………………………………
ADDRESS: ………………………………………………………………………………… PROVINCE: ……………
TELEPHONE: ……………………………………………………………..…………….
POSTAL CODE: ………..….……………..
EXT.: …………………..……………………………………………………….
EMAIL: ……………….………………………………………………………………………………………………………………………………………….…………………
RESERVATION *
Table of 10 people: $3,000
4 tickets and more: $300 per ticket
Individual seat: $325
DONATION
Unable to attend the event,
please accept my donation:
Table: _____ table(s) x $3,000 = $ _________
Seat(s): _____ seat(s) x $300 = $ _________
Seat(s): ______ seat(s) x $325 = $ _________
$1,000
$500
$325
$150
*In an effort to protect the environment, no ticket will be delivered.
All the information will be send by email mid-September.
PAYMENT
CHEQUE enclosed (payable to the WOMEN’S Y FOUNDATION)
VISA
MASTERCARD
CARD No: ………………………………………………………………………………….. EXPIRATION DATE: .................................................................
CARDHOLDER’S NAME: ……………………………………………………………… SIGNATURE: …………………….…………………………………………
A tax receipt will be issued for the deductible portion—Registration no.: 89251 6360 RR0001
Contact us for more information: 514 866-9944