Registration form

The asterisk means that this information is mandatory.

Signing up...

Which component are you signing up for?

Community component

Name of the organization or association:

Name of the street, neighbourhood or park that you will be cleaning up:

Cleanup date:

Additional volunteers may join the effort. Details of this cleanup blitz will be posted on the map.

Municipal component (registration over)

School component

Name of the school:

Address of the school (important for delivery):

Cleanup date:

 

Contact information

Name:


Phone number:

Work       Home       Cell

Mailing address:


Postal code:


E-mail:
 
Number of participants:
Single
Group: participants

 
Comments (500 characters):
 

How did you hear about the project?

Check off all that apply.

E-mail
Ville de Gatineau Web site
JeBénévole.ca Web site
Community association
Newspapers
School
TV
Radio
Poster
Word of mouth
Other:

The information you provide will be used to better serve you, and will remain confidential once received. However, Ville de Gatineau cannot guarantee the secure transmission of this information by e-mail. If you agree to submit it by e-mail, please click on Submit.

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