Annual General Meeting 2022

ADULT – PARTICIPANT 1

Information of the family contact person.

Title*

Mrs.
Mr.
Mx.

Name*

Name Surname

Address*

City*

Postal Code*

Phone (home)*

Mobile

E-mail*

Allergies/ dietary restrictions*

ADULT – PARTICIPANT 2

Will you be accompanied by another adult?*

Yes
No

Title*

Mrs.
Mr.
Mx.

Name*

Name Surname

Allergies/ dietary restrictions*

CHILD(REN) PRESENT FOR THE DAY

Will you be accompanied by children?*

No
One child
Two children
Three children

Name of Child 1*

Name Surname

Age of Child 1 (as of September 21, 2022)*

Allergies / dietary restrictions of Child 1*

Name of Child 2*

Name Surname

Age of Child 2 (as of September 21, 2022)*

Allergies / dietary restrictions of Child 2*

Name of Child 3*

Name Surname

Age of Child 3 (as of September 21, 2022)*

Allergies / dietary restrictions of Child 3*

ACCOMODATIONS FOR FRIDAY, 23rd SEPTEMBER

Only offered for participants living 250 km or more from Hotel & Suites Le Dauphin

Do you live 250 km or more from the Hotel & Suites Le Dauphin Drummondville?*

Yes
No

Hotel address: 600, Boulevard St-Joseph, Drummondville, Québec, J2C 2C1

Do you need accommodation for Friday night?*

Yes
No

Breakfast and lunch included, provided by Leucan.

Please indicate the number of adults*

Please indicate the number of children*

DINNER AND DANCE PARTY - SATURDAY 24th SEPTEMBER

Please indicate the number of adults who will participate*

Please indicate the number of children who will participate*

ACCOMODATIONS FOR SATURDAY 24th SEPTEMBER

Do you need accommodation on Saturday night?*

Yes
No

Please indicate the number of adults who will participate*

Please indicate the number of children who will participate*

BREAKFAST - SUNDAY 25th SEPTEMBER

Please indicate the number of adults who will participate*

Please indicate the number of children who will participate*

COMMENTS

Any comments? Leave your thoughts in the field below.

Annual General Meeting 2022