Contact 1 First Name Last Name Street Address City Postal Code State/Province Phone Number Email Language(s) spoken at home English-AnglaisFrench-FrançaisArabic-ArabeBengali-BengaliCantonese-CantonaisCree-CriGerman-AllemandHindi-HindiInuktitut-InuktitutItalian-ItalienMandarin-MandarinOjibway-OjibwayPersian (Farsi)-Persan (farsi)Polish-PolonaisPortuguese-PortugaisPunjabi-PendjabiRussian-RusseSpanish-EspagnolTagalog-TagalogTamil-TamilUrdu-OurdouVietnamese-VietnamienOther Indigenous Language-Autre langue autochtoneOther Language-Autre langue Region Provincial OfficeCentral East (Durham, Grey-Bruce, Hastings, Simcoe, Peterborough, York)Central West (Halton, Peel, Waterloo, Wellington)East (Kingston, Upper Canada, Ottawa)North (North East, Sault St. Marie, Sudbury, Thunder Bay)South (Brant, Haldimand, Hamilton, Niagara, Norfolk)TorontoWest (Chatham-Kent, Elgin, Huron-Perth, London, Sarnia-Lambton, Windsor-Essex) Leave this field blank
