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APPLICATION FORM
WHICH ACTIVITY(IES) ARE YOU INTERESTED IN VOLUNTEERING AT?
Please note that expedition volunteers must be graduated healthcare professionnals (physician, nurse or psychosocial professionnals) or journalist, photographer or blogger.
*
Double défi des deux Mario
Rase-O-Thon Marie-Hélène Côté
Expeditions
Les Courses CRYO
Other punctual events
VOLUNTEER INFORMATION
Last name
*
First name
*
Birthdate
*
+
Occupation
Physician
Nurse
Social worker
Journalist/Blogger
Photoprapher
Graphic designer
Translater
Other:
Other:
Address
City
Postal code
Country
*
Canada
United States
Other:
Other:
Province
*
Quebec
Alberta
British-Colombia
Prince-Edward-Island
Manitoba
New-Brunswick
Nova Scotia
Ontario
Saskatchewan
Newfoundland and Labrador
Northwest Territories
Nunavut
Yukon
Region
*
01 Bas-Saint-Laurent
02 Saguenay–Lac-Saint-Jean
03 Capitale Nationale
04 Mauricie
05 Estrie
06 Montréal
07 Outaouais
08 Abitibi-Témiscamingue
09 Côte-Nord
10 Nord du Québec
11 Gaspésie–Îles-de-la-Madeleine
12 Chaudière-Appalaches
13 Laval
14 Lanaudière
15 Laurentides
16 Montérégie
17 Centre-du-Québec
Telephone
*
Mobile
Email
*
Preferred language of correspondence
*
Français
English