Visitor's card for vacation | Pourvoirie Lac Geneviève d'Anticosti

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Fields marked with an asterisk (*) are required.

Information about you

Last name*

First name*

Address*

City*

Province/State*

Postal Code/Zip Code*

Phone work*

Phone home*

Cellular

Email*

Date of birth (yyyy-mm-dd)*

Information about your stay

Reason of stay*

Date of entrance (yyyy-mm-dd)*

Date of departure (yyyy-mm-dd)*

In case of emergency

Name*

Telephone*

Accompanying persons

Name

Date of birth (yyyy-mm-dd)

Name

Date of birth (yyyy-mm-dd)

Name

Date of birth (yyyy-mm-dd)

Name

Date of birth (yyyy-mm-dd)

Name

Date of birth (yyyy-mm-dd)

Security Question

Question : 5+8*

J'accepte que mes données soient recueillies et utilisées pour, et uniquement pour, faire mon inscription à ce séjour à la Pourvoirie Île d'Anticosti.