Authorize the original obituary

1Identify yourself

Obituary : Teiji Koizumi

First name

Last name

Email address

Relation to the deceased

Specify

I consent to receive emails from Echovita Inc or its partners, which include news, notifications and promotions.

2Give your consent

I, the undersigned, confirm that I hold the necessary rights, as author or in any other capacity in accordance with Canadian and Quebec laws, to allow and authorize Echovita inc. (as well as any company affiliated with the latter) to publish or republish the notice of death of the late Teiji Koizumi as well as the photograph accompanying this notice of death on the website: www.echovita.com