*First name: *Last name:
*Gender:


*Date of birth: / /
*Address: Apt.:
*City: *Province:
*Postal code:    
Email: *Daytime phone number:
* Answer the mathematical skill-testing question: (12 x 2) – 4 = ?
Enter the UPC code from any Canadian Reserve product
and DOUBLE YOUR CHANCES TO WIN!: Eligible products
(10-digit code) 

I am interested in receiving new product information,
coupons and special offers on Agropur's products.

* I have read and understand the contest rules and regulations.