Name

First Name*

Last Name*

Contact

Phone

Email address*

Other

When would you like to
move to the W/E?*
---November 2017December 2017January 2018February 2018March 2018April 2018Later

How many bedrooms are you looking for?*
---12

Do you need a parking space?*
---120

What age group do you belong to?*
---18- 25 ans26- 35 ans36- 45 ans46- 55 ans56 ans et plus

Occupation*
---Federal GovernmentProvincial GovernmentMunicipal GovernmentPrivateOther

How did you hear about the W/E?*
---Bus stationRoof adsNewspaperInternetMedia adsFacebookOther

How far is your workplace to the W/E?*
---0.5 km1 km1.5 km2 km5 km10 km et plus

*The field marked with asterisk are required.
Please be advised that we will not transmit or sell your personal information such as phone number, address, email address or your name to any company or organization.