Application Form

Please choose among the following categories

This section is reserved for A Members

Name*

Professional Title*

Position*

Company Name*

Address*

Postal address City Province Postal code

Telephone*

Email*

Website

Invoice contact

Would you like to receive notifications of confirmed avian influenza cases in Quebec?*

Note: Depending on your membership category, you may be automatically added to our mailing list to comply with CFIA requirements.

Would you like to be on our mailing lists for the event below?

Some of our communications are available in French and English. If applicable, what is your preferred language of communication?*

Identification of the Super Admin

The Super Admin is the main user, responsible for editing the Business Record page and add users.

Name

Telephone

Email

Send us your logo

Accepted formats: GIF, JPG and PNG
IMPORTANT: the image must be square with a minimum resolution of 500x500 pixels.

Accepted file types: jpg, gif, png, Max. file size: 2 MB.

Contact