Membership Form

Download the form in PDF or Fill the form below
Already a member of the ANQ or ANPQ? Please use the simplified inscription.

Personal Information

Gender*
Language*

Professional Information

If your practice address is the same as your personal address, click on Copy Personal Information.
Remove office

Office

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

Add a training course

Online directory

Do you wish to appear in our online directory of therapists?

Profile

Fill if your company name differs from your own name

Photo gallery

Internet and Social Networks

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Additional Information

Are you a legal resident or do you have a Canadian work permit ?*
Are you qualified to give treatments in Kinesitherapy?*
Are you qualified to give treatments in Orthotherapy?*
Do you want to receive communications for members only and renewal notice by mail or email?*
Where did you hear about our grouping?*
Do you wish to receive our newsletter?*
Do you wish to receive the offers of our partners by e-mail ?*
You can unsubscribe anytime by editing your profile.
I wish to register for:*