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Registration form for the Great ShakeOut

Your informations

I want to participate in the Great ShakeOut 2024!

First name

Surname

Email address

Region

Phone number

To participate in the Great ShakeOut you must click on the button I want to participate in the Great ShakeOut and fill out the form.

Your participation

Have you already participated in the Great ShakeOut of Quebec?

Yes No

How many people are participating with you for this edition?

0 to 5 6 to 10 11 to 20 20 and over

Which statement best describes the group you represent?

Individual/family Early childhood center or pre-kindergarten Primary or secondary school College or university Municipality Company

Nonprofit organization Provincial government Federal Government Head of civil security Other

Conclusion

Would you like to receive communications from the Great ShakeOut?

(only in French)

Yes No

Have you ever felt an earthquake?

Yes No

Do you have any further comments on this campaign?

Yes No

Write your comment

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