Inforoute FPT Subscription Form

*Name of organization:

Organization website:

*Address:

*Region:

requis

HTTP link to logo:

Details about representative

*Last name of representative:

First name of representative:

*Representative e-mail address:

*Representative telephone number:

Representative fax number:

*Title of representative:

Purchase order number for billing purposes:
Annual subscription, from July 1st to June 30th

*Organization:

Cégep or college

School board

Other educational organization

Public agency or government department