Reservation Form

First name:*        
Last Name:*        
Company Name:        
Address:*        
City:*        
Province:*        
Postal Code:*        
Phone Number:*        
Phone Extension (if any):        
Mobile Phone Number:        
Email:*        
Invitation Received From:*        

Enter Purchased Items Here*

Gold Sponsorship:       Limited quantity: 5	VIP Package:	500 $:	Other contribution:
Get visibility and 4 gourmet gift baskets for two people, wine and local gourmet products*   See Sponsorship Plan	Get 4 gourmet gift baskets for two people, wine and local gourmet products*	For each 500$, get 1 gourmet gift basket for two people*
8 000 $	5 000 $ or more Amount: $ :	500 $ QTY:	Amount: $:

*Delivery in the greater Quebec City area or order for pick-up from Quarante 7 restaurant.

*Businesses outside of Quebec City can elect to have their gift basket transferred to an organization or person of their choosing.
 

Payment Method

How will you be paying?:*        

• For bank transfer information, please contact giftofemergencyaction@redcross.ca

 

• Please send your check to: 

Marion Corderoch
Croix-Rouge canadienne, Québec
6, Place du commerce
Verdun (Québec) H3E 1P4

 

• For information: giftofemergencyaction@redcross.ca or Marion Corderoch 1 514 362-2930 ext. 3622903