Annual General Meeting 2024

Participants

Name*

First name Last name

Email address*

Confirmation of your participation and important information about the event will be sent to this address.

Address

Address City Province Postal code Country

Phone number*

Do you have any allergies or intolerances?

Yes
No

If yes, please specify:

Diet and food preferences: check if applicable.

Vegetarian
Vegan
Hallal/casher
No pork
Gluten-free
Lactose-free

Add a participant ?

Yes
No

Name

First name Last name

Age

Does this participant have any allergies or intolerances?

Yes
No

If yes, please specify:

Diet and food preferences: check if applicable.

Vegetarian
Vegan
Hallal/casher
No pork
Gluten-free
Lactose-free

Add a participant?

Yes
No

Name

First name Last name

Age

Does this participant have any allergies or intolerances?

Yes
No

If yes, please specify:

Diet and food preferences: check if applicable.

Vegetarian
Vegan
Hallal/casher
No pork
Gluten-free
Lactose-free

Add a participant?

Yes
No

Name*

First name Last name

Age

Does this participant have any allergies or intolerances?

Yes
No

If yes, please specify:

Diet and food preferences: check if applicable.

Vegetarian
Vegan
Hallal/casher
No pork
Gluten-free
Lactose-free

Add a participant?

Yes
No

Name*

First name Last name

Age

Does this participant have any allergies or intolerances?

Yes
No

If yes, please specify:

Diet and food preferences: check if applicable.

Vegetarian
Vegan
Hallal/casher
No pork
Gluten-free
Lactose-free

Add a participant?

Yes
No

Name*

First name Last name

Age

Does this participant have any allergies or intolerances?

Yes
No

If yes, please specify:

Diet and food preferences: check if applicable.

Vegetarian
Vegan
Hallal/casher
No pork
Gluten-free
Lactose-free

Add a participant?

Yes
No

Name*

First name Last name

Age

Does this participant have any allergies or intolerances?

Yes
No

If yes, please specify:

Diet and food preferences: check if applicable.

Vegetarian
Vegan
Hallal/casher
No pork
Gluten-free
Lactose-free

Add a participant?

Yes
No

Name*

First name Last name

Age

Does this participant have any allergies or intolerances?

Yes
No

If yes, please specify:

Diet and food preferences: check if applicable.

Vegetarian
Vegan
Hallal/casher
No pork
Gluten-free
Lactose-free

Accommodation and meals

Do you live more than 250 km from the Delta Hotel Trois-Rivières?

Yes
No

Hotel address: 1620 Notre Dame Centre Street, Trois-Rivières (QC) G9A 6E5

Would all of the above participants like to take advantage of the accommodations offered by Leucan on Friday evening, June 14?

Yes
No

Breakfast on Saturday, June 15 is included and offered by Leucan, upon presentation of a receipt. Only available to participants who live more than 250 km from the event location.

If no, please specify the number of adults and children

Will all the above-mentioned participants be present for the lunch served before the Annual General Meeting, from 11:30 a.m. to 12:30 p.m.?*

Yes
No

If no, please specify the number of adults and children.

Will all the above-mentioned participants be present for the dinner served after the Annual General Meeting, from 6 p.m. to 8 p.m.?*

Yes
No

If no, please specify the number of adults and children.

Would all the above participants like to enjoy an overnight stay at the hotel on Saturday, June 15?*

Yes
No

If no, please specify the number of adults and children occupying the room.

Consent form for adults and children over 14 years old

Consent*

I understand that this activity will be alcohol-free, according to Leucan’s policy.

I authorize the use of photos and videos taken of myself during the activity to represent Leucan's mission. I authorize that my name, images, voice and comments be used without limit of territory, media or language to promote Leucan's mission for a period of one year.

Yes, I authorize it.
No, I don’t authorize it.

Consent*

I agree to respect all instructions and guidelines of the activity organized by Leucan.

Consent*

I acknowledge that my participation in the activity may involve risks, and I hereby assume and freely accept all risks arising from my participation in this activity. I acknowledge and accept that Leucan declines all responsibility for the risks that my participation in the activity may entail and that Leucan cannot be held responsible for any damages of any kind (physical, moral or material) that I may suffer in connection with my participation in this activity. Therefore, I agree to release and hold harmless Leucan, the event organizers, volunteers, sponsors, partners and their respective employees and agents present at this activity from any and all liability for loss, damage or injury to myself as a participant or to my property that may arise or occur in connection with my participation in this activity, and I waive all rights with respect to the foregoing.

I, the undersigned, (name of the participant), accept the terms and conditions of this activity.*

First name Last name

Consent for another participant over 14 years old?*

Yes
No

I authorize the use of photos and videos taken of myself during the activity to represent Leucan's mission. I authorize that my name, images, voice and comments be used without limit of territory, media or language to promote Leucan's mission for a period of one year.*

Yes, I authorize it.
No, I don’t authorize it.

Consent*

I agree to respect all instructions and guidelines of the activity organized by Leucan.

Consent*

I acknowledge that my participation in the activity may involve risks, and I hereby assume and freely accept all risks arising from my participation in this activity. I acknowledge and accept that Leucan declines all responsibility for the risks that my participation in the activity may entail and that Leucan cannot be held responsible for any damages of any kind (physical, moral or material) that I may suffer in connection with my participation in this activity. Therefore, I agree to release and hold harmless Leucan, the event organizers, volunteers, sponsors, partners and their respective employees and agents present at this activity from any and all liability for loss, damage or injury to myself as a participant or to my property that may arise or occur in connection with my participation in this activity, and I waive all rights with respect to the foregoing.

I, the undersigned, (name of the participant), accept the terms and conditions of this activity.*

First Last

Consent for another participant over 14 years old?*

Yes
No

I authorize the use of photos and videos taken of myself during the activity to represent Leucan's mission. I authorize that my name, images, voice and comments be used without limit of territory, media or language to promote Leucan's mission for a period of one year.*

Yes, I authorize it.
No, I don’t authorize it.

Consent*

I agree to respect all instructions and guidelines of the activity organized by Leucan.

Consent*

I acknowledge that my participation in the activity may involve risks, and I hereby assume and freely accept all risks arising from my participation in this activity. I acknowledge and accept that Leucan declines all responsibility for the risks that my participation in the activity may entail and that Leucan cannot be held responsible for any damages of any kind (physical, moral or material) that I may suffer in connection with my participation in this activity. Therefore, I agree to release and hold harmless Leucan, the event organizers, volunteers, sponsors, partners and their respective employees and agents present at this activity from any and all liability for loss, damage or injury to myself as a participant or to my property that may arise or occur in connection with my participation in this activity, and I waive all rights with respect to the foregoing.

I, the undersigned, (name of the participant), accept the terms and conditions of this activity.*

First name Last name

Consent for another participant over 14 years old?*

Yes
No

I authorize the use of photos and videos taken of myself during the activity to represent Leucan's mission. I authorize that my name, images, voice and comments be used without limit of territory, media or language to promote Leucan's mission for a period of one year.*

Yes, I authorize it.
No, I don’t authorize it.

Consent*

I agree to respect all instructions and guidelines of the activity organized by Leucan.

Consent*

I acknowledge that my participation in the activity may involve risks, and I hereby assume and freely accept all risks arising from my participation in this activity. I acknowledge and accept that Leucan declines all responsibility for the risks that my participation in the activity may entail and that Leucan cannot be held responsible for any damages of any kind (physical, moral or material) that I may suffer in connection with my participation in this activity. Therefore, I agree to release and hold harmless Leucan, the event organizers, volunteers, sponsors, partners and their respective employees and agents present at this activity from any and all liability for loss, damage or injury to myself as a participant or to my property that may arise or occur in connection with my participation in this activity, and I waive all rights with respect to the foregoing.

I, the undersigned, (name of the participant), accept the terms and conditions of this activity.*

First Last

Consent for another participant over 14 years old?*

Yes
No

I authorize the use of photos and videos taken of myself during the activity to represent Leucan's mission. I authorize that my name, images, voice and comments be used without limit of territory, media or language to promote Leucan's mission for a period of one year.*

Yes, I authorize it.
No, I don’t authorize it.

Consent*

I agree to respect all instructions and guidelines of the activity organized by Leucan.

Consent*

I acknowledge that my participation in the activity may involve risks, and I hereby assume and freely accept all risks arising from my participation in this activity. I acknowledge and accept that Leucan declines all responsibility for the risks that my participation in the activity may entail and that Leucan cannot be held responsible for any damages of any kind (physical, moral or material) that I may suffer in connection with my participation in this activity. Therefore, I agree to release and hold harmless Leucan, the event organizers, volunteers, sponsors, partners and their respective employees and agents present at this activity from any and all liability for loss, damage or injury to myself as a participant or to my property that may arise or occur in connection with my participation in this activity, and I waive all rights with respect to the foregoing.

I, the undersigned, (name of the participant), accept the terms and conditions of this activity.*

First name Last name

Consent for another participant over 14 years old?*

Yes
No

I authorize the use of photos and videos taken of myself during the activity to represent Leucan's mission. I authorize that my name, images, voice and comments be used without limit of territory, media or language to promote Leucan's mission for a period of one year.*

Yes, I authorize it.
No, I don’t authorize it.

Consent*

I agree to respect all instructions and guidelines of the activity organized by Leucan.

Consent*

I acknowledge that my participation in the activity may involve risks, and I hereby assume and freely accept all risks arising from my participation in this activity. I acknowledge and accept that Leucan declines all responsibility for the risks that my participation in the activity may entail and that Leucan cannot be held responsible for any damages of any kind (physical, moral or material) that I may suffer in connection with my participation in this activity. Therefore, I agree to release and hold harmless Leucan, the event organizers, volunteers, sponsors, partners and their respective employees and agents present at this activity from any and all liability for loss, damage or injury to myself as a participant or to my property that may arise or occur in connection with my participation in this activity, and I waive all rights with respect to the foregoing.

I, the undersigned, (name of the participant), accept the terms and conditions of this activity.*

First name Last name

Consent for another participant over 14 years old?*

Yes
No

I authorize the use of photos and videos taken of myself during the activity to represent Leucan's mission. I authorize that my name, images, voice and comments be used without limit of territory, media or language to promote Leucan's mission for a period of one year.*

Yes, I authorize it.
No, I don’t authorize it.

Consent*

I agree to respect all instructions and guidelines of the activity organized by Leucan.

Consent*

I acknowledge that my participation in the activity may involve risks, and I hereby assume and freely accept all risks arising from my participation in this activity. I acknowledge and accept that Leucan declines all responsibility for the risks that my participation in the activity may entail and that Leucan cannot be held responsible for any damages of any kind (physical, moral or material) that I may suffer in connection with my participation in this activity. Therefore, I agree to release and hold harmless Leucan, the event organizers, volunteers, sponsors, partners and their respective employees and agents present at this activity from any and all liability for loss, damage or injury to myself as a participant or to my property that may arise or occur in connection with my participation in this activity, and I waive all rights with respect to the foregoing.

I, the undersigned, (name of the participant), accept the terms and conditions of this activity.*

First name Last name

Consent form for children under 14 years old

Would you like to add a consent form for a child under 14?*

Yes
No

Name of the child

First name Last name

Add another participant under 14 years old?*

Yes
No

Name of the child

First name Last name

Add another participant under 14 years old?*

Yes
No

Name

First name Last name

Add another participant under 14 years old?*

Yes
No

Name

First name Last name

Add another participant under 14 years old?*

Yes
No

Nom

First name Last name

I authorize that photos and videos taken of my child during the activity be used to represent Leucan's mission. I authorize that my child's name, images, voice and comments be used without limit of territory, media or language to promote Leucan's mission for a period of one year.*

Yes, I authorize it.
No, I don’t authorize it.

Consent*

I agree to respect all instructions and guidelines of the activity organized by Leucan.

Consent*

I acknowledge that my child’s participation in the activity may involve risks, and I hereby assume and freely accept all risks arising from their participation in this activity. I acknowledge and accept that Leucan declines all responsibility for the risks that my child’s participation in the activity may entail and that Leucan cannot be held responsible for any damages of any kind (physical, moral or material) that my child may suffer in connection with their participation in this activity. Therefore, I agree to release and hold harmless Leucan, the event organizers, volunteers, sponsors, partners and their respective employees and agents present at this activity from any and all liability for loss, damage or injury to my child as a participant or to my child’s property that may arise or occur in connection with their participation in this activity, and I waive all rights with respect to the foregoing.

I, the undersigned, (name of the parent/legal guardian), authorizes the children mentionned above to participate in this activity and accept the terms and conditions of this activity.*

First name Last name