Membership form for the LACROIX Shareholders' Club

Membership form for the LACROIX Shareholders’ Club

"*" indicates required fields

I would like to join the LACROIX Shareholders' Club

I hereby declare that I am a shareholder of LACROIX*

Registered shares

And/or bearer shares

Name*

First Last

Postal address*

Street Address City State / Province / Region ZIP / Postal Code Country

Email address*

Phone number*

Proof of title*

Accepted file types: gif, jpg, png, txt, rtf, html, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods, xml, Max. file size: 10 MB.

Conditions of membership*

I hereby declare that I have read the conditions of membership of the LACROIX Shareholders' Club and I undertake to respect them

Consent*

I agree to receive information in real time and to be invited to information meetings

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