Registration Sales Representation

Last name*
2nd name
First name*
2nd first ame
Date of birth*
DD slash MM slash YYYY
Cell (phone)*
Phone (residential)
E-mail*
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Sex*
Current address
Civic number*
Street name*
Apartment number
City*
Province*
Province
Zip code*
Residence status*
Permanent code (if you know it)
City of birth*
Native country*
Mother tongue*
Spoken languages*
Father's last name*
Father's first name*
Mother's last name*
Mother's first name*
Next sessions:*
How did you know us?
Please tick the following boxes to be able to submit the form:*
- I authorize Académie Québec to transmit this information to the ministry of Education and the school service center.
- I certify that all of this information is correct.

Current address