Personal Information Target Address Province*AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon % of GRS membership desired* —Please choose an option—I would like to learn more about Gas from Renewable SourcesI would like to opt for the Gas from Renewable Sources rate I understand that the personal information provided when filling out the online participation form is only used and necessary to receive Gazifère’s services, to participate in programs, or to respond to my enquiry, and in accordance to Gazifère’s Privacy Policy. By submitting this form, I authorize a representative from Gazifère to contact me in order to obtain more information about enrolling in the Gas from Renewable Sources Rate. I understand that by submitting this form, the Gas from Renewable Sources Rate will automatically be added to my account at the percentage mentioned above, and that no representative will contact me prior the enrollment. If you wish to learn more before opting in, please change your selection above. I understand that the percentage of my natural gas consumption that I attribute to the Gas from Renewable Sources Rate will not be delivered directly to me. In reality, I am acquiring the green attributes associated with gas from renewable sources. The financial estimates provided by Gazifère are for illustrative purposes only and Gazifère cannot be held responsible for any discrepancies between these estimates and my actual consumption. I understand that my subscription may be rescinded at any time by notifying Gazifère in writing or by telephone. For details about the cost of gas from renewable sources, please refer to Article 23.1 of our Condition of Service and Tariff. 81424