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Contest

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Name #session.nom#N/A

Company #session.compagnie#N/A

Address #session.adresse#N/A

City #session.ville#N/A

Postal code #session.codepostal#N/A

Phone number #session.telephone#N/A

Fax #session.fax#N/A

Email #session.courriel#N/A

Radio station listened to #session.station#N/A

Date of your next office party #session.date#N/A

Number of persons #session.nbpersonnes#N/A

#session.pubcontact#N/A
I wish to be contacted periodically by email and informed about Alcotest Quebec's promotional offers and new products.



	The only test in the world that detects the most commonly abused drugs that are used to spike drinks for the purpose of rape (more info ..)

Contest

To take part in the contest, please fill up the form bellow. You could win breathalyser tests for your next office party. The fields indicated by * are necessary

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Company	value="#session.compagnie#" id="compagnie" name="compagnie" type="text" maxlength="255" class="border1 bgcolor1 style1 size11 color1" style="width:200px;height:18px">
Address	value="#session.adresse#" name="adresse" id="adresse" type="text" maxlength="255" class="border1 bgcolor1 style1 size11 color1" style="width:300px;height:18px">
City	value="#session.ville#" id="ville" name="ville" type="text" maxlength="255" class="border1 bgcolor1 style1 size11 color1" style="width:200px;height:18px">
Postal code	value="#session.codepostal1#" id="codepostal1" name="codepostal1" type="text" maxlength="3" class="border1 bgcolor1 style1 size11 color1" style="width:29px;height:18px" onKeyup="autotablead(this, document.concoursForm.codepostal2);upperCase(this,0)"> value="#session.codepostal2#" name="codepostal2" type="text" maxlength="3" class="border1 bgcolor1 style1 size11 color1" style="width:29px;height:18px" onKeyup="autotablead(this, document.concoursForm.codereg);upperCase(this,0)">
* Phone number	value="#session.codereg#" name="codereg" id="codereg" type="text" class="border1 bgcolor1 style1 size11 color1" onKeyup="autotablead(this, document.concoursForm.numtel1)" size="4" maxlength="3" style="width:29px;height:18px"> value="#session.numtel1#" name="numtel1" type="text" class="border1 bgcolor1 style1 size11 color1" onKeyup="autotablead(this, document.concoursForm.numtel2)" size="4" maxlength="3" style="width:29px;height:18px"> - value="#session.numtel2#" name="numtel2" type="text" class="border1 bgcolor1 style1 size11 color1" size="5" maxlength="4" onKeyup="autotablead(this, document.concoursForm.coderegfax)" style="width:35px;height:18px">
Fax	value="#session.coderegfax#" name="coderegfax" id="coderegfax" type="text" class="border1 bgcolor1 style1 size11 color1" onKeyup="autotablead(this, document.concoursForm.numfax1)" size="4" maxlength="3" style="width:29px;height:18px"> value="#session.numfax1#" name="numfax1" type="text" class="border1 bgcolor1 style1 size11 color1" onKeyup="autotablead(this, document.concoursForm.numfax2)" size="4" maxlength="3" style="width:29px;height:18px"> - value="#session.numfax2#">
* Email	value="" name="courriel" id="courriel" type="text" maxlength="255" class="border1 bgcolor1 style1 size11 color1" style="width:200px;height:18px;">
Radio station listened to	value="#session.station#" name="station" id="station" type="text" maxlength="255" class="border1 bgcolor1 style1 size11 color1" style="width:300px;height:18px;">
Date of your next office party	value="#session.date#" name="date" id="date" type="text" maxlength="255" class="border1 bgcolor1 style1 size11 color1" style="width:100px;height:18px;">
Number of persons	value="#session.nbpersonnes#" name="nbpersonnes" id="nbpersonnes" type="text" maxlength="255" class="border1 bgcolor1 style1 size11 color1" style="width:40px;height:18px;">
Yes, I wish to be contacted periodically by email and informed about Alcotest Quebec's promotional offers and new products.
	participate



	The only test in the world that detects the most commonly abused drugs that are used to spike drinks for the purpose of rape (more info ..)