I undertake to send my check to the Fondation Québec Philanthrope at 100-1040, avenue Belvédère, Québec (Québec) G1S 3G3.

I authorize Fondation Québec Philanthrope to charge a direct debit according to the information on the following page.

I authorize Fondation Québec Philanthrope to charge a credit card transaction according to the information on the following page.