Membership Form

Download the form in PDF or Fill the form below

Already a member of the ANQ or RMQ? Please use the simplified inscription.
Personal InformationFirst name*
Last name*
E-mail address*
Password*
Confirmation*
Gender*

 Male
 Female
 Non binary
Language*

 French
 English
Birthdate (e.g.: YYYY-MM-DD)
Country*
Province*
Region*
Address*
City*
Postal code*
Phone*
Cellphone
Fax
ID Document*
Professional Information
If your practice address is the same as your personal address, click on Copy Personal Information.
Remove officeOfficeOffice name
Hide these coordinates

 No
 Yes
Country
Province*
Region*
Address
City
Postal code
Phone*
Cellphone
Fax
E-mail address
Add an office
     
Your practice address will be displayed in the audit module for insurers, on the site of the association, online. In addition, your business information will be displayed in the directory of therapists, online, searchable by the public.
If you do not want your business address to appear on the association's website (insurer module and directory), please indicate it here:
Career and training
        members_career_tooltip    
When did you start to practice? 
Enter the year.
Previous education
Specialisations 
Delete training courseSchoolSchool*
Program
Year*
Training hours
Degrees and/or certificates
Add a training courseOnline directoryDo you wish to appear in our online directory of therapists?

 No
 Yes
ProfileCompany name
        Fill if your company name differs from your own name    
Description in French
Description in English
Photo gallery
Video (YouTube or Vimeo)
Profile Image
Internet and Social NetworksWebsite
Twitter account
Facebook page
Skype@
LinkedIn page
Additional InformationAre you a legal resident or do you have a Canadian work permit ?*

 No
 Yes
Do you want to receive communications for members only and renewal notice by mail or email?*

 Mail
 E-mail
 Both
Where did you hear about our association?*

 Colleague
 Website
 Your training school
 Ad
 Other
Precise:*
Do you wish to receive our newsletter?*

 No
 Yes
Do you wish to receive the offers of our partners by e-mail ?*

 No
 Yes
You can unsubscribe anytime by editing your profile.
Other precisions concerning your membership submission
I wish to register for:*

 2023
 2023-2024

Membership Form

Personal Information

Professional Information

Office

Career and training members_career_tooltip

School

Online directory

Profile

Internet and Social Networks

Additional Information

Career and training

members_career_tooltip