{"id":2981,"date":"2021-08-03T10:34:36","date_gmt":"2021-08-03T14:34:36","guid":{"rendered":"https:\/\/alix.interligne.co\/formulaire-victime\/"},"modified":"2024-12-11T16:13:52","modified_gmt":"2024-12-11T21:13:52","slug":"formulaire-victime","status":"publish","type":"page","link":"https:\/\/alix.interligne.co\/en\/formulaire-victime\/","title":{"rendered":"Report a situation of violence"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Have you experienced violence or abuse?<\/h2>\n                            <p class='gform_description'>Any question marked with a (*) is mandatory.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/en\/wp-json\/wp\/v2\/pages\/2981#gf_1' data-formid='1' novalidate><input id=\"gpnf_session_hash_1\" type=\"hidden\" name=\"gpnf_session_hash\" value=\"7500622a38b9\"><div id='gf_page_steps_1' class='gf_page_steps'><div id='gf_step_1_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_1_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_1_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_1_4' class='gf_step gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_1_5' class='gf_step gf_step_pending'><span class='gf_step_number'>5<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_1_6' class='gf_step gf_step_pending'><span class='gf_step_number'>6<\/span><span class='gf_step_label'><\/span><\/div><div id='gf_step_1_7' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>7<\/span><span class='gf_step_label'><\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_1_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">1. YOUR SOCIO-DEMOGRAPHIC INFORMATION<\/h3><\/div><div id=\"field_1_21\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">What label best defines your gender identity?*<\/h3><div class='gsection_description' id='gfield_description_1_21'>You can select more than one option.<\/div><\/div><fieldset id=\"field_1_2\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1V &#8211; Identit\u00e9 de genre<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_2'><div class='gchoice gchoice_1_2_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.1' type='checkbox'  value='Femme'  id='choice_1_2_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_2_1' id='label_1_2_1' class='gform-field-label gform-field-label--type-inline'>Woman<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_2_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.2' type='checkbox'  value='Homme'  id='choice_1_2_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_2_2' id='label_1_2_2' class='gform-field-label gform-field-label--type-inline'>Man<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_2_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.3' type='checkbox'  value='Non-binaire'  id='choice_1_2_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_2_3' id='label_1_2_3' class='gform-field-label gform-field-label--type-inline'>Non-binary<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_2_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.4' type='checkbox'  value='Agenre'  id='choice_1_2_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_2_4' id='label_1_2_4' class='gform-field-label gform-field-label--type-inline'>Agender<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_2_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.5' type='checkbox'  value='Fluide dans le genre'  id='choice_1_2_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_2_5' id='label_1_2_5' class='gform-field-label gform-field-label--type-inline'>Gender fluid<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_2_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.6' type='checkbox'  value='Non conforme dans le genre'  id='choice_1_2_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_2_6' id='label_1_2_6' class='gform-field-label gform-field-label--type-inline'>Gender non conforming<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_2_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.7' type='checkbox'  value='En questionnement'  id='choice_1_2_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_2_7' id='label_1_2_7' class='gform-field-label gform-field-label--type-inline'>Questioning<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_2_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.8' type='checkbox'  value='Bispirituelle'  id='choice_1_2_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_2_8' id='label_1_2_8' class='gform-field-label gform-field-label--type-inline'>Two-spirit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_2_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.9' type='checkbox'  value='Queer'  id='choice_1_2_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_2_9' id='label_1_2_9' class='gform-field-label gform-field-label--type-inline'>Queer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_2_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.11' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_2_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_2_11' id='label_1_2_11' class='gform-field-label gform-field-label--type-inline'>Other(s) (Please specify)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_2_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_2.12' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_2_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_2_12' id='label_1_2_12' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_3'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_1_3' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_20\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">How old are you?*<\/h3><\/div><div id=\"field_1_172\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_172'>1V &#8211; \u00c2ge<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_172' id='input_1_172' type='number' step='any' min='0'  value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_1_172\" \/><div class='gfield_description instruction ' id='gfield_instruction_1_172'>Please enter a number greater than or equal to <strong>0<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_1_6\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1V &#8211; \u00c2ge<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_6'><div class='gchoice gchoice_1_6_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_6.1' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_6_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_6_1' id='label_1_6_1' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_22\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Which of these realities apply to you?*<\/h3><div class='gsection_description' id='gfield_description_1_22'>You can select more than one option.<\/div><\/div><fieldset id=\"field_1_7\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1V &#8211; Situation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_7'><div class='gchoice gchoice_1_7_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.1' type='checkbox'  value='J\u2019ai un parcours migratoire'  id='choice_1_7_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_1' id='label_1_7_1' class='gform-field-label gform-field-label--type-inline'>I have an immigrant background<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.2' type='checkbox'  value='Je suis une personne racis\u00e9e'  id='choice_1_7_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_2' id='label_1_7_2' class='gform-field-label gform-field-label--type-inline'>I am BIPOC (Black, Indigenous and people of colour)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.3' type='checkbox'  value='Je vis sous le seuil de la pauvret\u00e9'  id='choice_1_7_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_3' id='label_1_7_3' class='gform-field-label gform-field-label--type-inline'>I am a person living under the poverty line<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.4' type='checkbox'  value='Je vis \u00ab\u00e0 la paie\u00bb ou mon budget est serr\u00e9'  id='choice_1_7_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_4' id='label_1_7_4' class='gform-field-label gform-field-label--type-inline'>I am living paycheck to paycheck<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.5' type='checkbox'  value='Je suis en situation de handicap physique'  id='choice_1_7_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_5' id='label_1_7_5' class='gform-field-label gform-field-label--type-inline'>I am living with a physical disability<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.6' type='checkbox'  value='Je suis en situation d\u2019itin\u00e9rance'  id='choice_1_7_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_6' id='label_1_7_6' class='gform-field-label gform-field-label--type-inline'>I am in a situation of homelessness or couch surfing.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.7' type='checkbox'  value='Je vis avec des difficult\u00e9s de sant\u00e9 mentale, diagnostiqu\u00e9es ou non'  id='choice_1_7_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_7' id='label_1_7_7' class='gform-field-label gform-field-label--type-inline'>I am living with one or more mental health issues, diagnosed or not, including anxiety or depressive symptoms<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.8' type='checkbox'  value='J&#039;ai une neurodivergence, diagnostiqu\u00e9e ou non'  id='choice_1_7_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_8' id='label_1_7_8' class='gform-field-label gform-field-label--type-inline'>I am neurodivergent, diagnosed or not<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.9' type='checkbox'  value='J&#039;ai une ou plusieurs maladies chroniques'  id='choice_1_7_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_9' id='label_1_7_9' class='gform-field-label gform-field-label--type-inline'>I have one or more chronic illnesses<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.11' type='checkbox'  value='J\u2019appartiens \u00e0 une communaut\u00e9 religieuse ou spirituelle'  id='choice_1_7_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_11' id='label_1_7_11' class='gform-field-label gform-field-label--type-inline'>I am part of a religious or spiritual community<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.12' type='checkbox'  value='J\u2019ai un parcours trans'  id='choice_1_7_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_12' id='label_1_7_12' class='gform-field-label gform-field-label--type-inline'>I am trans<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.13' type='checkbox'  value='J&#039;ai un parcours d\u00e9trans ou j&#039;ai discontinu\u00e9 ma transition'  id='choice_1_7_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_13' id='label_1_7_13' class='gform-field-label gform-field-label--type-inline'>I am detrans, or I stopped my gender transition at some point<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.14' type='checkbox'  value='Je suis une personne vivant avec le VIH'  id='choice_1_7_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_14' id='label_1_7_14' class='gform-field-label gform-field-label--type-inline'>I am HIV-positive<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.15' type='checkbox'  value='Je vis avec une d\u00e9pendance'  id='choice_1_7_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_15' id='label_1_7_15' class='gform-field-label gform-field-label--type-inline'>I have an addiction (ie. alcohol, drugs, gambling, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.16' type='checkbox'  value='Je pratique une forme de travail du sexe'  id='choice_1_7_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_16' id='label_1_7_16' class='gform-field-label gform-field-label--type-inline'>I am or used to be a sex worker<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.17' type='checkbox'  value='Je fais partie des Premi\u00e8res nations, des peuples Inuits ou M\u00e9tis'  id='choice_1_7_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_17' id='label_1_7_17' class='gform-field-label gform-field-label--type-inline'>I am Indigenous (First Nations, Inuits or Metis)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.18' type='checkbox'  value='Je b\u00e9n\u00e9ficie d&#039;un soutien financier de l\u2019\u00c9tat'  id='choice_1_7_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_18' id='label_1_7_18' class='gform-field-label gform-field-label--type-inline'>I have a state economic support (i.e. social assistance, disability status, caregiver, etc.)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.19' type='checkbox'  value='Je viens d\u2019un milieu rural'  id='choice_1_7_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_19' id='label_1_7_19' class='gform-field-label gform-field-label--type-inline'>I am from a rural area<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.21' type='checkbox'  value='Je suis parent'  id='choice_1_7_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_21' id='label_1_7_21' class='gform-field-label gform-field-label--type-inline'>I am a parent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.22' type='checkbox'  value='Je suis une personne polyamoureuse ou \u00e9thiquement non-monogame'  id='choice_1_7_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_22' id='label_1_7_22' class='gform-field-label gform-field-label--type-inline'>I am polyamorous or ethically non-monogamous<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.23' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_7_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_23' id='label_1_7_23' class='gform-field-label gform-field-label--type-inline'>Other(s) (please specify below)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.24' type='checkbox'  value='Aucune de ces situations ne me concerne'  id='choice_1_7_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_24' id='label_1_7_24' class='gform-field-label gform-field-label--type-inline'>None of these situations concern me<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_7_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.25' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_7_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_7_25' id='label_1_7_25' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='mm_tooltip_text' style='display:none'><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><p>FR : Par exemple, danse \u00e9rotique, service d\u2019escorte, vente de vid\u00e9os ou de photos en ligne, etc. | EN : For example, erotic dancing, escort services, selling pictures or videos online, OnlyFans, etc.<\/p><\/div><\/fieldset><div id=\"field_1_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_9'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1_9' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_24\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Do you identify as part of the LGBTQI+ community?*<\/h3><\/div><fieldset id=\"field_1_168\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >1V &#8211; LGBTQI+?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_168'>\n\t\t\t<div class='gchoice gchoice_1_168_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_168' type='radio' value='Oui'  id='choice_1_168_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_168_0' id='label_1_168_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_168_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_168' type='radio' value='Non'  id='choice_1_168_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_168_1' id='label_1_168_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_168_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_168' type='radio' value='Je suis en questionnement'  id='choice_1_168_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_168_2' id='label_1_168_2' class='gform-field-label gform-field-label--type-inline'>I am in the process of questioning<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_11\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1V &#8211; LGBTQI+, Oui ou en questionnement<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_11'><div class='gchoice gchoice_1_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='Lesbienne'  id='choice_1_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_1' id='label_1_11_1' class='gform-field-label gform-field-label--type-inline'>Lesbian<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.2' type='checkbox'  value='Gaie'  id='choice_1_11_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_2' id='label_1_11_2' class='gform-field-label gform-field-label--type-inline'>Gay<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.3' type='checkbox'  value='Bisexuelle'  id='choice_1_11_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_3' id='label_1_11_3' class='gform-field-label gform-field-label--type-inline'>Bisexual<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.4' type='checkbox'  value='Trans'  id='choice_1_11_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_4' id='label_1_11_4' class='gform-field-label gform-field-label--type-inline'>Trans<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.5' type='checkbox'  value='Queer'  id='choice_1_11_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_5' id='label_1_11_5' class='gform-field-label gform-field-label--type-inline'>Queer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.6' type='checkbox'  value='Intersexe'  id='choice_1_11_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_6' id='label_1_11_6' class='gform-field-label gform-field-label--type-inline'>Intersex<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.7' type='checkbox'  value='Asexuelle'  id='choice_1_11_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_7' id='label_1_11_7' class='gform-field-label gform-field-label--type-inline'>Asexual<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.8' type='checkbox'  value='En questionnement'  id='choice_1_11_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_8' id='label_1_11_8' class='gform-field-label gform-field-label--type-inline'>Questioning<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.9' type='checkbox'  value='Non-binaire'  id='choice_1_11_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_9' id='label_1_11_9' class='gform-field-label gform-field-label--type-inline'>Non-binary<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.11' type='checkbox'  value='Bispirituelle'  id='choice_1_11_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_11' id='label_1_11_11' class='gform-field-label gform-field-label--type-inline'>Two-spirit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.12' type='checkbox'  value='Pansexuelle'  id='choice_1_11_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_12' id='label_1_11_12' class='gform-field-label gform-field-label--type-inline'>Pansexual<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.13' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_11_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_13' id='label_1_11_13' class='gform-field-label gform-field-label--type-inline'>Other(s) (Please specify)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_11_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.14' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_11_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_11_14' id='label_1_11_14' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='mm_tooltip_text' style='display:none'><hr \/><hr \/><hr \/><hr \/><p>FR : Inclut toute personne dont l\u2019identit\u00e9 de genre ne correspond pas au sexe assign\u00e9 \u00e0 la naissance | EN : Every person who&#8217;s gender identity doesn&#8217;t represent the sex they were assigned at birth.\u00a0<\/p><hr \/><hr \/><hr \/><p>FR : Inclut toute personne se trouvant sur le spectre de l\u2019asexualit\u00e9 |EN : Include all people identifying on the ace spectrum<\/p><hr \/><hr \/><p>FR : Inclut toute personne s\u2019identifiant autrement qu\u2019exclusivement homme ou femme | EN : Include every people who don&#8217;t identify as male or female only<\/p><\/div><\/fieldset><div id=\"field_1_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_12'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_1_12' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_23\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Where do you live now?  <\/h3><div class='gsection_description' id='gfield_description_1_23'>This information will only be used for statistical purposes and your identity will remain anonymous.<\/div><\/div><div id=\"field_1_173\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Country*<\/h3><\/div><div id=\"field_1_18\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_18'>1V &#8211; Pays<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_18' id='input_1_18' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Afrique du Sud' >South Africa<\/option><option value='Albanie' >Albania<\/option><option value='Alg\u00e9rie' >Algeria<\/option><option value='Allemagne' >Germany<\/option><option value='Andorre' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Antigua-et-Barbuda' >Antigua and Barbuda<\/option><option value='Arabie Saoudite' >Saudi Arabia<\/option><option value='Argentine' >Argentina<\/option><option value='Arm\u00e9nie' >Armenia<\/option><option value='Australie' >Australia<\/option><option value='Autriche' >Austria<\/option><option value='Azerba\u00efdjan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahre\u00efn' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbade' >Barbados<\/option><option value='Bi\u00e9lorussie' >Belarus<\/option><option value='Belgique' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='B\u00e9nin' >Benin<\/option><option value='Bhoutan' >Bhutan<\/option><option value='Bolivie' >Bolivia<\/option><option value='Bosnie-Herz\u00e9govine' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brunei' >Brunei<\/option><option value='Br\u00e9sil' >Brazil<\/option><option value='Bulgarie' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodge' >Cambodia<\/option><option value='Cameroun' >Cameroon<\/option><option value='Canada' selected='selected'>Canada<\/option><option value='Cap-Vert' >Cabo Verde<\/option><option value='Chili' >Chile<\/option><option value='Chine' >China<\/option><option value='Chypre' >Cyprus<\/option><option value='Colombie' >Colombia<\/option><option value='Comores' >Comoros<\/option><option value='Cor\u00e9e du Nord' >North Korea<\/option><option value='Cor\u00e9e du Sud' >South Korea<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatie' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cote d&#039;Ivoire' >Cote d&#039;Ivoire<\/option><option value='Danemark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominique' >Dominica<\/option><option value='\u00c9gypte' >Egypt<\/option><option value='\u00c9mirats arabes unis' >United Arab Emirates<\/option><option value='\u00c9quateur' >Ecuador<\/option><option value='\u00c9rythr\u00e9e' >Eritrea<\/option><option value='Espagne' >Spain<\/option><option value='Estonie' >Estonia<\/option><option value='Eswatini (Swaziland)' >Eswatini (Swaziland)<\/option><option value='\u00c9tats-Unis' >United States<\/option><option value='\u00c9thiopie' >Ethiopia<\/option><option value='Fidji' >Fiji<\/option><option value='Finlande' >Finland<\/option><option value='France' >France<\/option><option value='Gabon' >Gabon<\/option><option value='Gambie' >Gambia<\/option><option value='G\u00e9orgie' >Georgia<\/option><option value='Ghana' >Ghana<\/option><option value='Grenade' >Grenada<\/option><option value='Gr\u00e8ce' >Greece<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guin\u00e9e' >Guinea<\/option><option value='Guin\u00e9e \u00e9quatoriale' >Equatorial Guinea<\/option><option value='Guin\u00e9e-Bissau' >Guinea-Bissau<\/option><option value='Guyane' >Guyana<\/option><option value='Ha\u00efti' >Haiti<\/option><option value='Honduras' >Honduras<\/option><option value='Hongrie' >Hungary<\/option><option value='\u00celes Cook' >Cook Islands<\/option><option value='\u00celes Marshall' >Marshall Islands<\/option><option value='\u00celes Salomon' >Solomon Islands<\/option><option value='Inde' >India<\/option><option value='Indon\u00e9sie' >Indonesia<\/option><option value='Irak' >Iraq<\/option><option value='Iran' >Iran<\/option><option value='Irlande' >Ireland<\/option><option value='Islande' >Iceland<\/option><option value='Isra\u00ebl' >Israel<\/option><option value='Italie' >Italy<\/option><option value='Jama\u00efque' >Jamaica<\/option><option value='Japon' >Japan<\/option><option value='Jordanie' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kirghizistan' >Kyrgyzstan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kowe\u00eft' >Kuwait<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettonie' >Latvia<\/option><option value='Liban' >Lebanon<\/option><option value='Liberia' >Liberia<\/option><option value='Libye' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituanie' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malaisie' >Malaysia<\/option><option value='Malawi' >Malawi<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malte' >Malta<\/option><option value='Maroc' >Morocco<\/option><option value='Maurice' >Mauritius<\/option><option value='Mauritanie' >Mauritania<\/option><option value='Mexique' >Mexico<\/option><option value='Micron\u00e9sie' >Micronesia<\/option><option value='Moldavie' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolie' >Mongolia<\/option><option value='Mont\u00e9n\u00e9gro' >Montenegro<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibie' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nig\u00e9ria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norv\u00e8ge' >Norway<\/option><option value='Nouvelle-Z\u00e9lande' >New Zealand<\/option><option value='N\u00e9pal' >Nepal<\/option><option value='Oman' >Oman<\/option><option value='Ouganda' >Ouganda<\/option><option value='Ouzb\u00e9kistan' >Uzbekistan<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine' >Palestine<\/option><option value='Panama' >Panama<\/option><option value='Papouasie-Nouvelle-Guin\u00e9e' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Pays-Bas' >Netherlands<\/option><option value='Philippines' >Philippines<\/option><option value='Pologne' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='P\u00e9rou' >Peru<\/option><option value='Qatar' >Qatar<\/option><option value='R\u00e9publique Dominicaine' >Dominican Republic<\/option><option value='R\u00e9publique centrafricaine' >Central African Republic<\/option><option value='R\u00e9publique du Congo' >Congo, Republic of the<\/option><option value='R\u00e9publique d\u00e9mocratique du Congo' >Congo, Democratic Republic of<\/option><option value='R\u00e9publique d\u00e9mocratique populaire du Laos' >Laos<\/option><option value='Roumanie' >Romania<\/option><option value='Royaume-Uni' >United Kingdom<\/option><option value='Russie' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint-Christophe-et-Ni\u00e9v\u00e8s' >Saint Kitts and Nevis<\/option><option value='Saint-Marin' >Saint Marin<\/option><option value='Saint-Vincent-et-les Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Sainte-Lucie' >Saint Lucia<\/option><option value='Salvador' >El Salvador<\/option><option value='Samoa' >Samoa<\/option><option value='Sao Tom\u00e9 et Principe' >Sao Tome and Principe<\/option><option value='Serbie' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapour' >Singapore<\/option><option value='Slovaquie' >Slovakia<\/option><option value='Slov\u00e9nie' >Slovenia<\/option><option value='Somalie' >Somalia<\/option><option value='Soudan' >Sudan<\/option><option value='Soudan du Sud' >Sudan, South<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Suisse' >Switzerland<\/option><option value='Suriname' >Suriname<\/option><option value='Su\u00e8de' >Sweden<\/option><option value='Syrie' >Syria<\/option><option value='S\u00e9n\u00e9gal' >Senegal<\/option><option value='Ta\u00efwan' >Taiwan<\/option><option value='Tadjikistan' >Tadjikistan<\/option><option value='Tanzanie' >Tanzania<\/option><option value='Tchad' >Chad<\/option><option value='Tch\u00e9quie' >Czechia<\/option><option value='Tha\u00eflande' >Thailand<\/option><option value='Timor oriental' >East Timor (Timor-Leste)<\/option><option value='Togo' >Togo<\/option><option value='Tonga' >Tonga<\/option><option value='Trinit\u00e9 et Tobago' >Trinidad and Tobago<\/option><option value='Tunisie' >Tunisia<\/option><option value='Turkm\u00e9nistan' >Turmekistan<\/option><option value='Turquie' >Turkey<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Ukraine' >Ukraine<\/option><option value='Uruguay' >Uruguay<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Vatican' >Vatican City<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Y\u00e9men' >Yemen<\/option><option value='Zambie' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select><\/div><\/div><fieldset id=\"field_1_19\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1V &#8211; Pays<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_19'><div class='gchoice gchoice_1_19_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_19.1' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_19_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_19_1' id='label_1_19_1' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_30\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Province or territory<\/h3><\/div><div id=\"field_1_26\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_26'>1V &#8211; Province ou territoire<\/label><div class='ginput_container ginput_container_select'><select name='input_26' id='input_1_26' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Alberta' >Alberta<\/option><option value='Colombie-Britannique' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='Nouveau-Brunswick' >New Brunswick<\/option><option value='Terre-Neuve-et-Labrador' >Newfoundland and Labrador<\/option><option value='Territoires du Nord-Ouest' >Northwest Territories<\/option><option value='Nouvelle-\u00c9cosse' >Nova Scotia<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='\u00cele du Prince-\u00c9douard' >Prince Edward Island<\/option><option value='Qu\u00e9bec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select><\/div><\/div><fieldset id=\"field_1_28\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1V &#8211; Province ou territoire<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_28'><div class='gchoice gchoice_1_28_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.1' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_28_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_28_1' id='label_1_28_1' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_31\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">City or town<\/h3><\/div><div id=\"field_1_27\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_27'>1V &#8211; Ville ou village<\/label><div class='ginput_container ginput_container_select'><select name='input_27' id='input_1_27' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Abercorn' >Abercorn<\/option><option value='Abitibi' >Abitibi<\/option><option value='Abitibi-Ouest' >Abitibi-Ouest<\/option><option value='Acton' >Acton<\/option><option value='Acton Vale' >Acton Vale<\/option><option value='Adstock' >Adstock<\/option><option value='Aguanish' >Aguanish<\/option><option value='Akulivik' >Akulivik<\/option><option value='Albanel' >Albanel<\/option><option value='Albertville' >Albertville<\/option><option value='Alleyn-et-Cawood' >Alleyn-et-Cawood<\/option><option value='Alma' >Alma<\/option><option value='Amherst' >Amherst<\/option><option value='Amos' >Amos<\/option><option value='Amqui' >Amqui<\/option><option value='Ange-Gardien' >Ange-Gardien<\/option><option value='Antoine-Labelle' >Antoine-Labelle<\/option><option value='Argenteuil' >Argenteuil<\/option><option value='Armagh' >Armagh<\/option><option value='Arthabaska' >Arthabaska<\/option><option value='Arundel' >Arundel<\/option><option value='Asbestos' >Asbestos<\/option><option value='Ascot Corner' >Ascot Corner<\/option><option value='Aston-Jonction' >Aston-Jonction<\/option><option value='Auclair' >Auclair<\/option><option value='Audet' >Audet<\/option><option value='Aumond' >Aumond<\/option><option value='Aupaluk' >Aupaluk<\/option><option value='Austin' >Austin<\/option><option value='Authier' >Authier<\/option><option value='Authier-Nord' >Authier-Nord<\/option><option value='Avignon' >Avignon<\/option><option value='Ayer&#039;s Cliff' >Ayer&#039;s Cliff<\/option><option value='Baie-Comeau' >Baie-Comeau<\/option><option value='Baie-D&#039;Urf\u00e9' >Baie-D&#039;Urf\u00e9<\/option><option value='Baie-Johan-Beetz' >Baie-Johan-Beetz<\/option><option value='Baie-Saint-Paul' >Baie-Saint-Paul<\/option><option value='Baie-Sainte-Catherine' >Baie-Sainte-Catherine<\/option><option value='Baie-Trinit\u00e9' >Baie-Trinit\u00e9<\/option><option value='Baie-des-Sables' >Baie-des-Sables<\/option><option value='Baie-du-Febvre' >Baie-du-Febvre<\/option><option value='Barkmere' >Barkmere<\/option><option value='Barnston-Ouest' >Barnston-Ouest<\/option><option value='Barraute' >Barraute<\/option><option value='Batiscan' >Batiscan<\/option><option value='Batiscan' >Batiscan<\/option><option value='B\u00e9arn' >B\u00e9arn<\/option><option value='Beauce-Sartigan' >Beauce-Sartigan<\/option><option value='Beauceville' >Beauceville<\/option><option value='Beauharnois' >Beauharnois<\/option><option value='Beauharnois-Salaberry' >Beauharnois-Salaberry<\/option><option value='Beaulac-Garthby' >Beaulac-Garthby<\/option><option value='Beaumont' >Beaumont<\/option><option value='Beaupr\u00e9' >Beaupr\u00e9<\/option><option value='B\u00e9cancour' >B\u00e9cancour<\/option><option value='B\u00e9cancour' >B\u00e9cancour<\/option><option value='Bedford' >Bedford<\/option><option value='B\u00e9gin' >B\u00e9gin<\/option><option value='Belcourt' >Belcourt<\/option><option value='Bellechasse' >Bellechasse<\/option><option value='Belleterre' >Belleterre<\/option><option value='Beloeil' >Beloeil<\/option><option value='Berry' >Berry<\/option><option value='Berthier-sur-Mer' >Berthier-sur-Mer<\/option><option value='Berthierville' >Berthierville<\/option><option value='B\u00e9thanie' >B\u00e9thanie<\/option><option value='Biencourt' >Biencourt<\/option><option value='Blainville' >Blainville<\/option><option value='Blanc-Sablon' >Blanc-Sablon<\/option><option value='Blue Sea' >Blue Sea<\/option><option value='Boileau' >Boileau<\/option><option value='Bois-Franc' >Bois-Franc<\/option><option value='Bois-des-Filion' >Bois-des-Filion<\/option><option value='Boisbriand' >Boisbriand<\/option><option value='Boischatel' >Boischatel<\/option><option value='Bolton-Est' >Bolton-Est<\/option><option value='Bolton-Ouest' >Bolton-Ouest<\/option><option value='Bonaventure' >Bonaventure<\/option><option value='Bonne-Esp\u00e9rance' >Bonne-Esp\u00e9rance<\/option><option value='Bonsecours' >Bonsecours<\/option><option value='Boucherville' >Boucherville<\/option><option value='Bouchette' >Bouchette<\/option><option value='Bowman' >Bowman<\/option><option value='Br\u00e9beuf' >Br\u00e9beuf<\/option><option value='Brigham' >Brigham<\/option><option value='Bristol' >Bristol<\/option><option value='Brome' >Brome<\/option><option value='Brome-Missisquoi' >Brome-Missisquoi<\/option><option value='Bromont' >Bromont<\/option><option value='Brossard' >Brossard<\/option><option value='Brownsburg-Chatham' >Brownsburg-Chatham<\/option><option value='Bryson' >Bryson<\/option><option value='Bury' >Bury<\/option><option value='Cacouna' >Cacouna<\/option><option value='Calixa-Lavall\u00e9e' >Calixa-Lavall\u00e9e<\/option><option value='Campbell&#039;s Bay' >Campbell&#039;s Bay<\/option><option value='Candiac' >Candiac<\/option><option value='Caniapiscau' >Caniapiscau<\/option><option value='Cantley' >Cantley<\/option><option value='Cap-Chat' >Cap-Chat<\/option><option value='Cap-Saint-Ignace' >Cap-Saint-Ignace<\/option><option value='Cap-Sant\u00e9' >Cap-Sant\u00e9<\/option><option value='Caplan' >Caplan<\/option><option value='Carignan' >Carignan<\/option><option value='Carleton-sur-Mer' >Carleton-sur-Mer<\/option><option value='Cascap\u00e9dia--Saint-Jules' >Cascap\u00e9dia&#8211;Saint-Jules<\/option><option value='Causapscal' >Causapscal<\/option><option value='Cayamant' >Cayamant<\/option><option value='Chambly' >Chambly<\/option><option value='Chambord' >Chambord<\/option><option value='Champlain' >Champlain<\/option><option value='Champneuf' >Champneuf<\/option><option value='Chandler' >Chandler<\/option><option value='Chapais' >Chapais<\/option><option value='Charette' >Charette<\/option><option value='Charlemagne' >Charlemagne<\/option><option value='Charlevoix' >Charlevoix<\/option><option value='Charlevoix-Est' >Charlevoix-Est<\/option><option value='Chartierville' >Chartierville<\/option><option value='Ch\u00e2teau-Richer' >Ch\u00e2teau-Richer<\/option><option value='Ch\u00e2teauguay' >Ch\u00e2teauguay<\/option><option value='Chazel' >Chazel<\/option><option value='Chelsea' >Chelsea<\/option><option value='Ch\u00e9n\u00e9ville' >Ch\u00e9n\u00e9ville<\/option><option value='Chertsey' >Chertsey<\/option><option value='Chesterville' >Chesterville<\/option><option value='Chibougamau' >Chibougamau<\/option><option value='Chichester' >Chichester<\/option><option value='Chisasibi' >Chisasibi<\/option><option value='Chute-Saint-Philippe' >Chute-Saint-Philippe<\/option><option value='Chute-aux-Outardes' >Chute-aux-Outardes<\/option><option value='Clarendon' >Clarendon<\/option><option value='Clermont' >Clermont<\/option><option value='Clermont' >Clermont<\/option><option value='Clerval' >Clerval<\/option><option value='Cleveland' >Cleveland<\/option><option value='Cloridorme' >Cloridorme<\/option><option value='Coaticook' >Coaticook<\/option><option value='Colombier' >Colombier<\/option><option value='Compton' >Compton<\/option><option value='Contrec\u0153ur' >Contrec\u0153ur<\/option><option value='Cookshire-Eaton' >Cookshire-Eaton<\/option><option value='C\u00f4te-Nord-du-Golfe-du-Saint-Laurent' >C\u00f4te-Nord-du-Golfe-du-Saint-Laurent<\/option><option value='C\u00f4te-Saint-Luc' >C\u00f4te-Saint-Luc<\/option><option value='Coteau-du-Lac' >Coteau-du-Lac<\/option><option value='Courcelles' >Courcelles<\/option><option value='Cowansville' >Cowansville<\/option><option value='Crabtree' >Crabtree<\/option><option value='D&#039;Autray' >D&#039;Autray<\/option><option value='Danville' >Danville<\/option><option value='Daveluyville' >Daveluyville<\/option><option value='D\u00e9gelis' >D\u00e9gelis<\/option><option value='D\u00e9l\u00e9age' >D\u00e9l\u00e9age<\/option><option value='Delson' >Delson<\/option><option value='Denholm' >Denholm<\/option><option value='Desbiens' >Desbiens<\/option><option value='Deschaillons-sur-Saint-Laurent' >Deschaillons-sur-Saint-Laurent<\/option><option value='Deschambault-Grondines' >Deschambault-Grondines<\/option><option value='Deux-Montagnes' >Deux-Montagnes<\/option><option value='Disraeli' >Disraeli<\/option><option value='Dixville' >Dixville<\/option><option value='Dolbeau-Mistassini' >Dolbeau-Mistassini<\/option><option value='Dollard-Des Ormeaux' >Dollard-Des Ormeaux<\/option><option value='Donnacona' >Donnacona<\/option><option value='Dorval' >Dorval<\/option><option value='Dosquet' >Dosquet<\/option><option value='Drummond' >Drummond<\/option><option value='Drummondville' >Drummondville<\/option><option value='Dudswell' >Dudswell<\/option><option value='Duhamel' >Duhamel<\/option><option value='Duhamel-Ouest' >Duhamel-Ouest<\/option><option value='Dundee' >Dundee<\/option><option value='Dunham' >Dunham<\/option><option value='Duparquet' >Duparquet<\/option><option value='Dupuy' >Dupuy<\/option><option value='Durham-Sud' >Durham-Sud<\/option><option value='East Angus' >East Angus<\/option><option value='East Broughton' >East Broughton<\/option><option value='East Farnham' >East Farnham<\/option><option value='East Hereford' >East Hereford<\/option><option value='Eastmain' >Eastmain<\/option><option value='Eastman' >Eastman<\/option><option value='Eeyou-Istchee Baie-James' >Eeyou-Istchee Baie-James<\/option><option value='Egan-Sud' >Egan-Sud<\/option><option value='Elgin' >Elgin<\/option><option value='Entrelacs' >Entrelacs<\/option><option value='Escuminac' >Escuminac<\/option><option value='Esprit-Saint' >Esprit-Saint<\/option><option value='Est\u00e9rel' >Est\u00e9rel<\/option><option value='Farnham' >Farnham<\/option><option value='Fassett' >Fassett<\/option><option value='Ferland-et-Boilleau' >Ferland-et-Boilleau<\/option><option value='Ferme-Neuve' >Ferme-Neuve<\/option><option value='Fermont' >Fermont<\/option><option value='Forestville' >Forestville<\/option><option value='Fort-Coulonge' >Fort-Coulonge<\/option><option value='Fortierville' >Fortierville<\/option><option value='Fossambault-sur-le-Lac' >Fossambault-sur-le-Lac<\/option><option value='Frampton' >Frampton<\/option><option value='Franklin' >Franklin<\/option><option value='Franquelin' >Franquelin<\/option><option value='Frelighsburg' >Frelighsburg<\/option><option value='Frontenac' >Frontenac<\/option><option value='Fug\u00e8reville' >Fug\u00e8reville<\/option><option value='Gallichan' >Gallichan<\/option><option value='Gasp\u00e9' >Gasp\u00e9<\/option><option value='Gatineau' >Gatineau<\/option><option value='Girardville' >Girardville<\/option><option value='Godbout' >Godbout<\/option><option value='Godmanchester' >Godmanchester<\/option><option value='Gore' >Gore<\/option><option value='Gracefield' >Gracefield<\/option><option value='Granby' >Granby<\/option><option value='Grand-M\u00e9tis' >Grand-M\u00e9tis<\/option><option value='Grand-Remous' >Grand-Remous<\/option><option value='Grand-Saint-Esprit' >Grand-Saint-Esprit<\/option><option value='Grande-Rivi\u00e8re' >Grande-Rivi\u00e8re<\/option><option value='Grande-Vall\u00e9e' >Grande-Vall\u00e9e<\/option><option value='Grandes-Piles' >Grandes-Piles<\/option><option value='Grenville' >Grenville<\/option><option value='Grenville-sur-la-Rouge' >Grenville-sur-la-Rouge<\/option><option value='Gros-M\u00e9catina' >Gros-M\u00e9catina<\/option><option value='Grosse-\u00cele' >Grosse-\u00cele<\/option><option value='Grosses-Roches' >Grosses-Roches<\/option><option value='Gu\u00e9rin' >Gu\u00e9rin<\/option><option value='Ham Sud' >Ham Sud<\/option><option value='Ham-Nord' >Ham-Nord<\/option><option value='Hampden' >Hampden<\/option><option value='Hampstead' >Hampstead<\/option><option value='Harrington' >Harrington<\/option><option value='Hatley' >Hatley<\/option><option value='Havelock' >Havelock<\/option><option value='Havre-Saint-Pierre' >Havre-Saint-Pierre<\/option><option value='H\u00e9bertville' >H\u00e9bertville<\/option><option value='H\u00e9bertville-Station' >H\u00e9bertville-Station<\/option><option value='Hemmingford' >Hemmingford<\/option><option value='Henryville' >Henryville<\/option><option value='H\u00e9rouxville' >H\u00e9rouxville<\/option><option value='Hinchinbrooke' >Hinchinbrooke<\/option><option value='Honfleur' >Honfleur<\/option><option value='Hope' >Hope<\/option><option value='Hope Town' >Hope Town<\/option><option value='Howick' >Howick<\/option><option value='Huberdeau' >Huberdeau<\/option><option value='Hudson' >Hudson<\/option><option value='Huntingdon' >Huntingdon<\/option><option value='Inukjuak' >Inukjuak<\/option><option value='Inverness' >Inverness<\/option><option value='Irlande' >Irlande<\/option><option value='Ivry-sur-le-Lac' >Ivry-sur-le-Lac<\/option><option value='Ivujivik' >Ivujivik<\/option><option value='Joliette' >Joliette<\/option><option value='Kamouraska' >Kamouraska<\/option><option value='Kangiqsualujjuaq' >Kangiqsualujjuaq<\/option><option value='Kangiqsujuaq' >Kangiqsujuaq<\/option><option value='Kangirsuk' >Kangirsuk<\/option><option value='Kawawachikamach' >Kawawachikamach<\/option><option value='Kazabazua' >Kazabazua<\/option><option value='Kiamika' >Kiamika<\/option><option value='Kingsbury' >Kingsbury<\/option><option value='Kingsey Falls' >Kingsey Falls<\/option><option value='Kinnear&#039;s Mills' >Kinnear&#039;s Mills<\/option><option value='Kipawa' >Kipawa<\/option><option value='Kirkland' >Kirkland<\/option><option value='Kuujjuaq' >Kuujjuaq<\/option><option value='Kuujjuarapik' >Kuujjuarapik<\/option><option value='L&#039;Ancienne-Lorette' >L&#039;Ancienne-Lorette<\/option><option value='L&#039;Ange-Gardien' >L&#039;Ange-Gardien<\/option><option value='L&#039;Anse-Saint-Jean' >L&#039;Anse-Saint-Jean<\/option><option value='L&#039;Ascension' >L&#039;Ascension<\/option><option value='L&#039;Ascension-de-Notre-Seigneur' >L&#039;Ascension-de-Notre-Seigneur<\/option><option value='L&#039;Ascension-de-Patap\u00e9dia' >L&#039;Ascension-de-Patap\u00e9dia<\/option><option value='L&#039;Assomption' >L&#039;Assomption<\/option><option value='L&#039;Assomption' >L&#039;Assomption<\/option><option value='L&#039;Avenir' >L&#039;Avenir<\/option><option value='L&#039;\u00c9piphanie' >L&#039;\u00c9piphanie<\/option><option value='L&#039;\u00c9rable' >L&#039;\u00c9rable<\/option><option value='L&#039;\u00cele-Cadieux' >L&#039;\u00cele-Cadieux<\/option><option value='L&#039;\u00cele-Dorval' >L&#039;\u00cele-Dorval<\/option><option value='L&#039;\u00cele-Perrot' >L&#039;\u00cele-Perrot<\/option><option value='L&#039;\u00cele-d&#039;Anticosti' >L&#039;\u00cele-d&#039;Anticosti<\/option><option value='L&#039;\u00cele-d&#039;Orl\u00e9ans' >L&#039;\u00cele-d&#039;Orl\u00e9ans<\/option><option value='L&#039;\u00cele-du-Grand-Calumet' >L&#039;\u00cele-du-Grand-Calumet<\/option><option value='L&#039;Isle-Verte' >L&#039;Isle-Verte<\/option><option value='L&#039;Isle-aux-Allumettes' >L&#039;Isle-aux-Allumettes<\/option><option value='L&#039;Isle-aux-Coudres' >L&#039;Isle-aux-Coudres<\/option><option value='L&#039;Islet' >L&#039;Islet<\/option><option value='La Bostonnais' >La Bostonnais<\/option><option value='La Conception' >La Conception<\/option><option value='La Corne' >La Corne<\/option><option value='La C\u00f4te-de-Beaupr\u00e9' >La C\u00f4te-de-Beaupr\u00e9<\/option><option value='La C\u00f4te-de-Gasp\u00e9' >La C\u00f4te-de-Gasp\u00e9<\/option><option value='La Dor\u00e9' >La Dor\u00e9<\/option><option value='La Durantaye' >La Durantaye<\/option><option value='La Guadeloupe' >La Guadeloupe<\/option><option value='La Haute-C\u00f4te-Nord' >La Haute-C\u00f4te-Nord<\/option><option value='La Haute-Gasp\u00e9sie' >La Haute-Gasp\u00e9sie<\/option><option value='La Haute-Yamaska' >La Haute-Yamaska<\/option><option value='La Jacques-Cartier' >La Jacques-Cartier<\/option><option value='La Macaza' >La Macaza<\/option><option value='La Malbaie' >La Malbaie<\/option><option value='La Martre' >La Martre<\/option><option value='La Matanie' >La Matanie<\/option><option value='La Matap\u00e9dia' >La Matap\u00e9dia<\/option><option value='La Minerve' >La Minerve<\/option><option value='La Mitis' >La Mitis<\/option><option value='La Morandi\u00e8re' >La Morandi\u00e8re<\/option><option value='La Motte' >La Motte<\/option><option value='La Nouvelle-Beauce' >La Nouvelle-Beauce<\/option><option value='La Patrie' >La Patrie<\/option><option value='La P\u00eache' >La P\u00eache<\/option><option value='La Pocati\u00e8re' >La Pocati\u00e8re<\/option><option value='La Prairie' >La Prairie<\/option><option value='La Pr\u00e9sentation' >La Pr\u00e9sentation<\/option><option value='La R\u00e9demption' >La R\u00e9demption<\/option><option value='La Reine' >La Reine<\/option><option value='La Rivi\u00e8re-du-Nord' >La Rivi\u00e8re-du-Nord<\/option><option value='La Sarre' >La Sarre<\/option><option value='La Trinit\u00e9-des-Monts' >La Trinit\u00e9-des-Monts<\/option><option value='La Tuque' >La Tuque<\/option><option value='La Vall\u00e9e-de-l&#039;Or' >La Vall\u00e9e-de-l&#039;Or<\/option><option value='La Vall\u00e9e-de-la-Gatineau' >La Vall\u00e9e-de-la-Gatineau<\/option><option value='La Vall\u00e9e-du-Richelieu' >La Vall\u00e9e-du-Richelieu<\/option><option value='La Visitation-de-Yamaska' >La Visitation-de-Yamaska<\/option><option value='La Visitation-de-l&#039;\u00cele-Dupas' >La Visitation-de-l&#039;\u00cele-Dupas<\/option><option value='Labelle' >Labelle<\/option><option value='Labrecque' >Labrecque<\/option><option value='Lac-Beauport' >Lac-Beauport<\/option><option value='Lac-Bouchette' >Lac-Bouchette<\/option><option value='Lac-Brome' >Lac-Brome<\/option><option value='Lac-Delage' >Lac-Delage<\/option><option value='Lac-Drolet' >Lac-Drolet<\/option><option value='Lac-\u00c9douard' >Lac-\u00c9douard<\/option><option value='Lac-Etchemin' >Lac-Etchemin<\/option><option value='Lac-Fronti\u00e8re' >Lac-Fronti\u00e8re<\/option><option value='Lac-M\u00e9gantic' >Lac-M\u00e9gantic<\/option><option value='Lac-Poulin' >Lac-Poulin<\/option><option value='Lac-Saguay' >Lac-Saguay<\/option><option value='Lac-Saint-Jean-Est' >Lac-Saint-Jean-Est<\/option><option value='Lac-Saint-Joseph' >Lac-Saint-Joseph<\/option><option value='Lac-Saint-Paul' >Lac-Saint-Paul<\/option><option value='Lac-Sainte-Marie' >Lac-Sainte-Marie<\/option><option value='Lac-Sergent' >Lac-Sergent<\/option><option value='Lac-Simon' >Lac-Simon<\/option><option value='Lac-Sup\u00e9rieur' >Lac-Sup\u00e9rieur<\/option><option value='Lac-Tremblant-Nord' >Lac-Tremblant-Nord<\/option><option value='Lac-au-Saumon' >Lac-au-Saumon<\/option><option value='Lac-aux-Sables' >Lac-aux-Sables<\/option><option value='Lac-des-Aigles' >Lac-des-Aigles<\/option><option value='Lac-des-\u00c9corces' >Lac-des-\u00c9corces<\/option><option value='Lac-des-Plages' >Lac-des-Plages<\/option><option value='Lac-des-Seize-\u00celes' >Lac-des-Seize-\u00celes<\/option><option value='Lac-du-Cerf' >Lac-du-Cerf<\/option><option value='Lachute' >Lachute<\/option><option value='Lacolle' >Lacolle<\/option><option value='Laforce' >Laforce<\/option><option value='Lamarche' >Lamarche<\/option><option value='Lambton' >Lambton<\/option><option value='Landrienne' >Landrienne<\/option><option value='Lanoraie' >Lanoraie<\/option><option value='Lantier' >Lantier<\/option><option value='Larouche' >Larouche<\/option><option value='Latulipe-et-Gaboury' >Latulipe-et-Gaboury<\/option><option value='Launay' >Launay<\/option><option value='Laurier-Station' >Laurier-Station<\/option><option value='Laurierville' >Laurierville<\/option><option value='Laval' >Laval<\/option><option value='Lavaltrie' >Lavaltrie<\/option><option value='Laverloch\u00e8re Angliers' >Laverloch\u00e8re Angliers<\/option><option value='Lawrenceville' >Lawrenceville<\/option><option value='Le Domaine-du-Roy' >Le Domaine-du-Roy<\/option><option value='Le Fjord-du-Saguenay' >Le Fjord-du-Saguenay<\/option><option value='Le Golfe-du-Saint-Laurent' >Le Golfe-du-Saint-Laurent<\/option><option value='Le Granit' >Le Granit<\/option><option value='Le Haut-Richelieu' >Le Haut-Richelieu<\/option><option value='Le Haut-Saint-Fran\u00e7ois' >Le Haut-Saint-Fran\u00e7ois<\/option><option value='Le Haut-Saint-Laurent' >Le Haut-Saint-Laurent<\/option><option value='Le Rocher-Perc\u00e9' >Le Rocher-Perc\u00e9<\/option><option value='Le Val-Saint-Fran\u00e7ois' >Le Val-Saint-Fran\u00e7ois<\/option><option value='Lebel-sur-Qu\u00e9villon' >Lebel-sur-Qu\u00e9villon<\/option><option value='Leclercville' >Leclercville<\/option><option value='Lefebvre' >Lefebvre<\/option><option value='Lejeune' >Lejeune<\/option><option value='Lemieux' >Lemieux<\/option><option value='L\u00e9ry' >L\u00e9ry<\/option><option value='Les Appalaches' >Les Appalaches<\/option><option value='Les Basques' >Les Basques<\/option><option value='Les Bergeronnes' >Les Bergeronnes<\/option><option value='Les C\u00e8dres' >Les C\u00e8dres<\/option><option value='Les Chenaux' >Les Chenaux<\/option><option value='Les Collines-de-l&#039;Outaouais' >Les Collines-de-l&#039;Outaouais<\/option><option value='Les Coteaux' >Les Coteaux<\/option><option value='Les \u00c9boulements' >Les \u00c9boulements<\/option><option value='Les Escoumins' >Les Escoumins<\/option><option value='Les Etchemins' >Les Etchemins<\/option><option value='Les Hauteurs' >Les Hauteurs<\/option><option value='Les \u00celes-de-la-Madeleine' >Les \u00celes-de-la-Madeleine<\/option><option value='Les Jardins-de-Napierville' >Les Jardins-de-Napierville<\/option><option value='Les Laurentides' >Les Laurentides<\/option><option value='Les Maskoutains' >Les Maskoutains<\/option><option value='Les M\u00e9chins' >Les M\u00e9chins<\/option><option value='Les Moulins' >Les Moulins<\/option><option value='Les Pays-d&#039;en-Haut' >Les Pays-d&#039;en-Haut<\/option><option value='Les Sources' >Les Sources<\/option><option value='L\u00e9vis' >L\u00e9vis<\/option><option value='Lingwick' >Lingwick<\/option><option value='Litchfield' >Litchfield<\/option><option value='Lochaber' >Lochaber<\/option><option value='Lochaber-Partie-Ouest' >Lochaber-Partie-Ouest<\/option><option value='Longue-Pointe-de-Mingan' >Longue-Pointe-de-Mingan<\/option><option value='Longue-Rive' >Longue-Rive<\/option><option value='Longueuil' >Longueuil<\/option><option value='Lorraine' >Lorraine<\/option><option value='Lorrainville' >Lorrainville<\/option><option value='Lotbini\u00e8re' >Lotbini\u00e8re<\/option><option value='Louiseville' >Louiseville<\/option><option value='Low' >Low<\/option><option value='Lyster' >Lyster<\/option><option value='Macamic' >Macamic<\/option><option value='Maddington Falls' >Maddington Falls<\/option><option value='Magog' >Magog<\/option><option value='Malartic' >Malartic<\/option><option value='Mandeville' >Mandeville<\/option><option value='Manicouagan' >Manicouagan<\/option><option value='Maniwaki' >Maniwaki<\/option><option value='Manseau' >Manseau<\/option><option value='Mansfield-et-Pontefract' >Mansfield-et-Pontefract<\/option><option value='Marguerite-D&#039;Youville' >Marguerite-D&#039;Youville<\/option><option value='Maria' >Maria<\/option><option value='Maria-Chapdelaine' >Maria-Chapdelaine<\/option><option value='Maricourt' >Maricourt<\/option><option value='Marieville' >Marieville<\/option><option value='Marsoui' >Marsoui<\/option><option value='Marston' >Marston<\/option><option value='Martinville' >Martinville<\/option><option value='Mascouche' >Mascouche<\/option><option value='Maskinong\u00e9' >Maskinong\u00e9<\/option><option value='Maskinong\u00e9' >Maskinong\u00e9<\/option><option value='Massueville' >Massueville<\/option><option value='Matagami' >Matagami<\/option><option value='Matane' >Matane<\/option><option value='Matap\u00e9dia' >Matap\u00e9dia<\/option><option value='Matawinie' >Matawinie<\/option><option value='Mayo' >Mayo<\/option><option value='McMasterville' >McMasterville<\/option><option value='M\u00e9kinac' >M\u00e9kinac<\/option><option value='Melbourne' >Melbourne<\/option><option value='Memphr\u00e9magog' >Memphr\u00e9magog<\/option><option value='Mercier' >Mercier<\/option><option value='Messines' >Messines<\/option><option value='M\u00e9tabetchouan--Lac-\u00e0-la-Croix' >M\u00e9tabetchouan&#8211;Lac-\u00e0-la-Croix<\/option><option value='M\u00e9tis-sur-Mer' >M\u00e9tis-sur-Mer<\/option><option value='Milan' >Milan<\/option><option value='Mille-Isles' >Mille-Isles<\/option><option value='Minganie' >Minganie<\/option><option value='Mirabel' >Mirabel<\/option><option value='Mistissini' >Mistissini<\/option><option value='Moffet' >Moffet<\/option><option value='Mont-Carmel' >Mont-Carmel<\/option><option value='Mont-Joli' >Mont-Joli<\/option><option value='Mont-Laurier' >Mont-Laurier<\/option><option value='Mont-Royal' >Mont-Royal<\/option><option value='Mont-Saint-Gr\u00e9goire' >Mont-Saint-Gr\u00e9goire<\/option><option value='Mont-Saint-Hilaire' >Mont-Saint-Hilaire<\/option><option value='Mont-Saint-Michel' >Mont-Saint-Michel<\/option><option value='Mont-Saint-Pierre' >Mont-Saint-Pierre<\/option><option value='Mont-Tremblant' >Mont-Tremblant<\/option><option value='Montcalm' >Montcalm<\/option><option value='Montcerf-Lytton' >Montcerf-Lytton<\/option><option value='Montebello' >Montebello<\/option><option value='Montmagny' >Montmagny<\/option><option value='Montpellier' >Montpellier<\/option><option value='Montr\u00e9al' >Montr\u00e9al<\/option><option value='Montr\u00e9al-Est' >Montr\u00e9al-Est<\/option><option value='Montr\u00e9al-Ouest' >Montr\u00e9al-Ouest<\/option><option value='Morin-Heights' >Morin-Heights<\/option><option value='Mulgrave-et-Derry' >Mulgrave-et-Derry<\/option><option value='Murdochville' >Murdochville<\/option><option value='Namur' >Namur<\/option><option value='Nantes' >Nantes<\/option><option value='Napierville' >Napierville<\/option><option value='Natashquan' >Natashquan<\/option><option value='N\u00e9d\u00e9lec' >N\u00e9d\u00e9lec<\/option><option value='Nemaska' >Nemaska<\/option><option value='Neuville' >Neuville<\/option><option value='New Carlisle' >New Carlisle<\/option><option value='New Richmond' >New Richmond<\/option><option value='Newport' >Newport<\/option><option value='Nicolet' >Nicolet<\/option><option value='Nicolet-Yamaska' >Nicolet-Yamaska<\/option><option value='Nominingue' >Nominingue<\/option><option value='Normandin' >Normandin<\/option><option value='Norm\u00e9tal' >Norm\u00e9tal<\/option><option value='North Hatley' >North Hatley<\/option><option value='Notre-Dame-Auxiliatrice-de-Buckland' >Notre-Dame-Auxiliatrice-de-Buckland<\/option><option value='Notre-Dame-de-Bonsecours' >Notre-Dame-de-Bonsecours<\/option><option value='Notre-Dame-de-Ham' >Notre-Dame-de-Ham<\/option><option value='Notre-Dame-de-Lorette' >Notre-Dame-de-Lorette<\/option><option value='Notre-Dame-de-Lourdes' >Notre-Dame-de-Lourdes<\/option><option value='Notre-Dame-de-Montauban' >Notre-Dame-de-Montauban<\/option><option value='Notre-Dame-de-Pontmain' >Notre-Dame-de-Pontmain<\/option><option value='Notre-Dame-de-Stanbridge' >Notre-Dame-de-Stanbridge<\/option><option value='Notre-Dame-de-l&#039;\u00cele-Perrot' >Notre-Dame-de-l&#039;\u00cele-Perrot<\/option><option value='Notre-Dame-de-la-Merci' >Notre-Dame-de-la-Merci<\/option><option value='Notre-Dame-de-la-Paix' >Notre-Dame-de-la-Paix<\/option><option value='Notre-Dame-de-la-Salette' >Notre-Dame-de-la-Salette<\/option><option value='Notre-Dame-des-Anges' >Notre-Dame-des-Anges<\/option><option value='Notre-Dame-des-Bois' >Notre-Dame-des-Bois<\/option><option value='Notre-Dame-des-Monts' >Notre-Dame-des-Monts<\/option><option value='Notre-Dame-des-Neiges' >Notre-Dame-des-Neiges<\/option><option value='Notre-Dame-des-Pins' >Notre-Dame-des-Pins<\/option><option value='Notre-Dame-des-Prairies' >Notre-Dame-des-Prairies<\/option><option value='Notre-Dame-des-Sept-Douleurs' >Notre-Dame-des-Sept-Douleurs<\/option><option value='Notre-Dame-du-Bon-Conseil' >Notre-Dame-du-Bon-Conseil<\/option><option value='Notre-Dame-du-Bon-Conseil' >Notre-Dame-du-Bon-Conseil<\/option><option value='Notre-Dame-du-Laus' >Notre-Dame-du-Laus<\/option><option value='Notre-Dame-du-Mont-Carmel' >Notre-Dame-du-Mont-Carmel<\/option><option value='Notre-Dame-du-Nord' >Notre-Dame-du-Nord<\/option><option value='Notre-Dame-du-Portage' >Notre-Dame-du-Portage<\/option><option value='Notre-Dame-du-Rosaire' >Notre-Dame-du-Rosaire<\/option><option value='Notre-Dame-du-Sacr\u00e9-C\u0153ur-d&#039;Issoudun' >Notre-Dame-du-Sacr\u00e9-C\u0153ur-d&#039;Issoudun<\/option><option value='Nouvelle' >Nouvelle<\/option><option value='Noyan' >Noyan<\/option><option value='Ogden' >Ogden<\/option><option value='Oka' >Oka<\/option><option value='Orford' >Orford<\/option><option value='Ormstown' >Ormstown<\/option><option value='Otter Lake' >Otter Lake<\/option><option value='Otterburn Park' >Otterburn Park<\/option><option value='Packington' >Packington<\/option><option value='Padoue' >Padoue<\/option><option value='Palmarolle' >Palmarolle<\/option><option value='Papineau' >Papineau<\/option><option value='Papineauville' >Papineauville<\/option><option value='Parisville' >Parisville<\/option><option value='Pasp\u00e9biac' >Pasp\u00e9biac<\/option><option value='Perc\u00e9' >Perc\u00e9<\/option><option value='P\u00e9ribonka' >P\u00e9ribonka<\/option><option value='Petit-Saguenay' >Petit-Saguenay<\/option><option value='Petite-Rivi\u00e8re-Saint-Fran\u00e7ois' >Petite-Rivi\u00e8re-Saint-Fran\u00e7ois<\/option><option value='Petite-Vall\u00e9e' >Petite-Vall\u00e9e<\/option><option value='Piedmont' >Piedmont<\/option><option value='Pierre-De Saurel' >Pierre-De Saurel<\/option><option value='Pierreville' >Pierreville<\/option><option value='Pike-River' >Pike-River<\/option><option value='Pincourt' >Pincourt<\/option><option value='Piopolis' >Piopolis<\/option><option value='Plaisance' >Plaisance<\/option><option value='Plessisville' >Plessisville<\/option><option value='Poh\u00e9n\u00e9gamook' >Poh\u00e9n\u00e9gamook<\/option><option value='Pointe-Calumet' >Pointe-Calumet<\/option><option value='Pointe-Claire' >Pointe-Claire<\/option><option value='Pointe-Fortune' >Pointe-Fortune<\/option><option value='Pointe-Lebel' >Pointe-Lebel<\/option><option value='Pointe-\u00e0-la-Croix' >Pointe-\u00e0-la-Croix<\/option><option value='Pointe-aux-Outardes' >Pointe-aux-Outardes<\/option><option value='Pointe-des-Cascades' >Pointe-des-Cascades<\/option><option value='Pont-Rouge' >Pont-Rouge<\/option><option value='Pontiac' >Pontiac<\/option><option value='Port-Cartier' >Port-Cartier<\/option><option value='Port-Daniel--Gascons' >Port-Daniel&#8211;Gascons<\/option><option value='Portage-du-Fort' >Portage-du-Fort<\/option><option value='Portage-du-Fort' >Portage-du-Fort<\/option><option value='Portneuf-sur-Mer' >Portneuf-sur-Mer<\/option><option value='Potton' >Potton<\/option><option value='Poularies' >Poularies<\/option><option value='Preissac' >Preissac<\/option><option value='Pr\u00e9vost' >Pr\u00e9vost<\/option><option value='Price' >Price<\/option><option value='Princeville' >Princeville<\/option><option value='Puvirnituq' >Puvirnituq<\/option><option value='Quaqtaq' >Quaqtaq<\/option><option value='Quebec City' >Quebec City<\/option><option value='Racine' >Racine<\/option><option value='Ragueneau' >Ragueneau<\/option><option value='Rapide-Danseur' >Rapide-Danseur<\/option><option value='Rapides-des-Joachims' >Rapides-des-Joachims<\/option><option value='Rawdon' >Rawdon<\/option><option value='R\u00e9migny' >R\u00e9migny<\/option><option value='Repentigny' >Repentigny<\/option><option value='Richelieu' >Richelieu<\/option><option value='Richmond' >Richmond<\/option><option value='Rigaud' >Rigaud<\/option><option value='Rimouski' >Rimouski<\/option><option value='Rimouski-Neigette' >Rimouski-Neigette<\/option><option value='Ripon' >Ripon<\/option><option value='Ristigouche-Partie-Sud-Est' >Ristigouche-Partie-Sud-Est<\/option><option value='Rivi\u00e8re-Beaudette' >Rivi\u00e8re-Beaudette<\/option><option value='Rivi\u00e8re-Bleue' >Rivi\u00e8re-Bleue<\/option><option value='Rivi\u00e8re-\u00c9ternit\u00e9' >Rivi\u00e8re-\u00c9ternit\u00e9<\/option><option value='Rivi\u00e8re-H\u00e9va' >Rivi\u00e8re-H\u00e9va<\/option><option value='Rivi\u00e8re-Ouelle' >Rivi\u00e8re-Ouelle<\/option><option value='Rivi\u00e8re-Rouge' >Rivi\u00e8re-Rouge<\/option><option value='Rivi\u00e8re-Saint-Jean' >Rivi\u00e8re-Saint-Jean<\/option><option value='Rivi\u00e8re-\u00e0-Claude' >Rivi\u00e8re-\u00e0-Claude<\/option><option value='Rivi\u00e8re-\u00e0-Pierre' >Rivi\u00e8re-\u00e0-Pierre<\/option><option value='Rivi\u00e8re-au-Tonnerre' >Rivi\u00e8re-au-Tonnerre<\/option><option value='Rivi\u00e8re-du-Loup' >Rivi\u00e8re-du-Loup<\/option><option value='Rivi\u00e8re-du-Loup' >Rivi\u00e8re-du-Loup<\/option><option value='Robert-Cliche' >Robert-Cliche<\/option><option value='Roberval' >Roberval<\/option><option value='Rochebaucourt' >Rochebaucourt<\/option><option value='Roquemaure' >Roquemaure<\/option><option value='Rosem\u00e8re' >Rosem\u00e8re<\/option><option value='Rougemont' >Rougemont<\/option><option value='Roussillon' >Roussillon<\/option><option value='Rouville' >Rouville<\/option><option value='Rouyn-Noranda' >Rouyn-Noranda<\/option><option value='Roxton' >Roxton<\/option><option value='Roxton Falls' >Roxton Falls<\/option><option value='Roxton Pond' >Roxton Pond<\/option><option value='Sacr\u00e9-C\u0153ur' >Sacr\u00e9-C\u0153ur<\/option><option value='Sacr\u00e9-C\u0153ur-de-J\u00e9sus' >Sacr\u00e9-C\u0153ur-de-J\u00e9sus<\/option><option value='Saguenay' >Saguenay<\/option><option value='Saint-Adalbert' >Saint-Adalbert<\/option><option value='Saint-Adelme' >Saint-Adelme<\/option><option value='Saint-Adelphe' >Saint-Adelphe<\/option><option value='Saint-Adolphe-d&#039;Howard' >Saint-Adolphe-d&#039;Howard<\/option><option value='Saint-Adrien' >Saint-Adrien<\/option><option value='Saint-Adrien-d&#039;Irlande' >Saint-Adrien-d&#039;Irlande<\/option><option value='Saint-Agapit' >Saint-Agapit<\/option><option value='Saint-Aim\u00e9' >Saint-Aim\u00e9<\/option><option value='Saint-Aim\u00e9-des-Lacs' >Saint-Aim\u00e9-des-Lacs<\/option><option value='Saint-Aim\u00e9-du-Lac-des-\u00celes' >Saint-Aim\u00e9-du-Lac-des-\u00celes<\/option><option value='Saint-Alban' >Saint-Alban<\/option><option value='Saint-Albert' >Saint-Albert<\/option><option value='Saint-Alexandre' >Saint-Alexandre<\/option><option value='Saint-Alexandre-de-Kamouraska' >Saint-Alexandre-de-Kamouraska<\/option><option value='Saint-Alexandre-des-Lacs' >Saint-Alexandre-des-Lacs<\/option><option value='Saint-Alexis' >Saint-Alexis<\/option><option value='Saint-Alexis-de-Matap\u00e9dia' >Saint-Alexis-de-Matap\u00e9dia<\/option><option value='Saint-Alexis-des-Monts' >Saint-Alexis-des-Monts<\/option><option value='Saint-Alfred' >Saint-Alfred<\/option><option value='Saint-Alphonse' >Saint-Alphonse<\/option><option value='Saint-Alphonse-Rodriguez' >Saint-Alphonse-Rodriguez<\/option><option value='Saint-Alphonse-de-Granby' >Saint-Alphonse-de-Granby<\/option><option value='Saint-Amable' >Saint-Amable<\/option><option value='Saint-Ambroise' >Saint-Ambroise<\/option><option value='Saint-Ambroise-de-Kildare' >Saint-Ambroise-de-Kildare<\/option><option value='Saint-Anaclet-de-Lessard' >Saint-Anaclet-de-Lessard<\/option><option value='Saint-Andr\u00e9' >Saint-Andr\u00e9<\/option><option value='Saint-Andr\u00e9-Avellin' >Saint-Andr\u00e9-Avellin<\/option><option value='Saint-Andr\u00e9-d&#039;Argenteuil' >Saint-Andr\u00e9-d&#039;Argenteuil<\/option><option value='Saint-Andr\u00e9-de-Restigouche' >Saint-Andr\u00e9-de-Restigouche<\/option><option value='Saint-Andr\u00e9-du-Lac-Saint-Jean' >Saint-Andr\u00e9-du-Lac-Saint-Jean<\/option><option value='Saint-Anicet' >Saint-Anicet<\/option><option value='Saint-Anselme' >Saint-Anselme<\/option><option value='Saint-Antoine-de-Tilly' >Saint-Antoine-de-Tilly<\/option><option value='Saint-Antoine-de-l&#039;Isle-aux-Grues' >Saint-Antoine-de-l&#039;Isle-aux-Grues<\/option><option value='Saint-Antoine-sur-Richelieu' >Saint-Antoine-sur-Richelieu<\/option><option value='Saint-Antonin' >Saint-Antonin<\/option><option value='Saint-Apollinaire' >Saint-Apollinaire<\/option><option value='Saint-Armand' >Saint-Armand<\/option><option value='Saint-Ars\u00e8ne' >Saint-Ars\u00e8ne<\/option><option value='Saint-Athanase' >Saint-Athanase<\/option><option value='Saint-Aubert' >Saint-Aubert<\/option><option value='Saint-Augustin' >Saint-Augustin<\/option><option value='Saint-Augustin' >Saint-Augustin<\/option><option value='Saint-Augustin-de-Desmaures' >Saint-Augustin-de-Desmaures<\/option><option value='Saint-Augustin-de-Woburn' >Saint-Augustin-de-Woburn<\/option><option value='Saint-Barnab\u00e9' >Saint-Barnab\u00e9<\/option><option value='Saint-Barnab\u00e9-Sud' >Saint-Barnab\u00e9-Sud<\/option><option value='Saint-Barth\u00e9lemy' >Saint-Barth\u00e9lemy<\/option><option value='Saint-Basile' >Saint-Basile<\/option><option value='Saint-Basile-le-Grand' >Saint-Basile-le-Grand<\/option><option value='Saint-Benjamin' >Saint-Benjamin<\/option><option value='Saint-Beno\u00eet-Labre' >Saint-Beno\u00eet-Labre<\/option><option value='Saint-Beno\u00eet-du-Lac' >Saint-Beno\u00eet-du-Lac<\/option><option value='Saint-Bernard' >Saint-Bernard<\/option><option value='Saint-Bernard-de-Lacolle' >Saint-Bernard-de-Lacolle<\/option><option value='Saint-Bernard-de-Michaudville' >Saint-Bernard-de-Michaudville<\/option><option value='Saint-Blaise-sur-Richelieu' >Saint-Blaise-sur-Richelieu<\/option><option value='Saint-Bonaventure' >Saint-Bonaventure<\/option><option value='Saint-Boniface' >Saint-Boniface<\/option><option value='Saint-Bruno' >Saint-Bruno<\/option><option value='Saint-Bruno-de-Guigues' >Saint-Bruno-de-Guigues<\/option><option value='Saint-Bruno-de-Kamouraska' >Saint-Bruno-de-Kamouraska<\/option><option value='Saint-Bruno-de-Montarville' >Saint-Bruno-de-Montarville<\/option><option value='Saint-Calixte' >Saint-Calixte<\/option><option value='Saint-Camille' >Saint-Camille<\/option><option value='Saint-Camille-de-Lellis' >Saint-Camille-de-Lellis<\/option><option value='Saint-Casimir' >Saint-Casimir<\/option><option value='Saint-C\u00e9lestin' >Saint-C\u00e9lestin<\/option><option value='Saint-C\u00e9saire' >Saint-C\u00e9saire<\/option><option value='Saint-Charles-Borrom\u00e9e' >Saint-Charles-Borrom\u00e9e<\/option><option value='Saint-Charles-Garnier' >Saint-Charles-Garnier<\/option><option value='Saint-Charles-de-Bellechasse' >Saint-Charles-de-Bellechasse<\/option><option value='Saint-Charles-de-Bourget' >Saint-Charles-de-Bourget<\/option><option value='Saint-Charles-sur-Richelieu' >Saint-Charles-sur-Richelieu<\/option><option value='Saint-Christophe-d&#039;Arthabaska' >Saint-Christophe-d&#039;Arthabaska<\/option><option value='Saint-Chrysostome' >Saint-Chrysostome<\/option><option value='Saint-Claude' >Saint-Claude<\/option><option value='Saint-Cl\u00e9ment' >Saint-Cl\u00e9ment<\/option><option value='Saint-Cl\u00e9ophas' >Saint-Cl\u00e9ophas<\/option><option value='Saint-Cl\u00e9ophas-de-Brandon' >Saint-Cl\u00e9ophas-de-Brandon<\/option><option value='Saint-Clet' >Saint-Clet<\/option><option value='Saint-Colomban' >Saint-Colomban<\/option><option value='Saint-C\u00f4me' >Saint-C\u00f4me<\/option><option value='Saint-C\u00f4me-Lini\u00e8re' >Saint-C\u00f4me-Lini\u00e8re<\/option><option value='Saint-Constant' >Saint-Constant<\/option><option value='Saint-Cuthbert' >Saint-Cuthbert<\/option><option value='Saint-Cyprien' >Saint-Cyprien<\/option><option value='Saint-Cyprien' >Saint-Cyprien<\/option><option value='Saint-Cyprien-de-Napierville' >Saint-Cyprien-de-Napierville<\/option><option value='Saint-Cyrille-de-Lessard' >Saint-Cyrille-de-Lessard<\/option><option value='Saint-Cyrille-de-Wendover' >Saint-Cyrille-de-Wendover<\/option><option value='Saint-Damase' >Saint-Damase<\/option><option value='Saint-Damase-de-L&#039;Islet' >Saint-Damase-de-L&#039;Islet<\/option><option value='Saint-Damien' >Saint-Damien<\/option><option value='Saint-Damien-de-Buckland' >Saint-Damien-de-Buckland<\/option><option value='Saint-David' >Saint-David<\/option><option value='Saint-David-de-Falardeau' >Saint-David-de-Falardeau<\/option><option value='Saint-Denis-de-Brompton' >Saint-Denis-de-Brompton<\/option><option value='Saint-Denis-de-la-Bouteillerie' >Saint-Denis-de-la-Bouteillerie<\/option><option value='Saint-Denis-sur-Richelieu' >Saint-Denis-sur-Richelieu<\/option><option value='Saint-Denis-sur-Richelieu' >Saint-Denis-sur-Richelieu<\/option><option value='Saint-Dominique' >Saint-Dominique<\/option><option value='Saint-Dominique-du-Rosaire' >Saint-Dominique-du-Rosaire<\/option><option value='Saint-Donat' >Saint-Donat<\/option><option value='Saint-Edmond-de-Grantham' >Saint-Edmond-de-Grantham<\/option><option value='Saint-Edmond-les-Plaines' >Saint-Edmond-les-Plaines<\/option><option value='Saint-\u00c9douard' >Saint-\u00c9douard<\/option><option value='Saint-\u00c9douard-de-Fabre' >Saint-\u00c9douard-de-Fabre<\/option><option value='Saint-\u00c9douard-de-Lotbini\u00e8re' >Saint-\u00c9douard-de-Lotbini\u00e8re<\/option><option value='Saint-\u00c9douard-de-Maskinong\u00e9' >Saint-\u00c9douard-de-Maskinong\u00e9<\/option><option value='Saint-\u00c9lie-de-Caxton' >Saint-\u00c9lie-de-Caxton<\/option><option value='Saint-\u00c9loi' >Saint-\u00c9loi<\/option><option value='Saint-Elph\u00e8ge' >Saint-Elph\u00e8ge<\/option><option value='Saint-Elz\u00e9ar' >Saint-Elz\u00e9ar<\/option><option value='Saint-Elz\u00e9ar-de-T\u00e9miscouata' >Saint-Elz\u00e9ar-de-T\u00e9miscouata<\/option><option value='Saint-\u00c9mile-de-Suffolk' >Saint-\u00c9mile-de-Suffolk<\/option><option value='Saint-\u00c9phrem-de-Beauce' >Saint-\u00c9phrem-de-Beauce<\/option><option value='Saint-\u00c9piphane' >Saint-\u00c9piphane<\/option><option value='Saint-Esprit' >Saint-Esprit<\/option><option value='Saint-\u00c9tienne-de-Beauharnois' >Saint-\u00c9tienne-de-Beauharnois<\/option><option value='Saint-\u00c9tienne-de-Bolton' >Saint-\u00c9tienne-de-Bolton<\/option><option value='Saint-\u00c9tienne-des-Gr\u00e8s' >Saint-\u00c9tienne-des-Gr\u00e8s<\/option><option value='Saint-Eug\u00e8ne' >Saint-Eug\u00e8ne<\/option><option value='Saint-Eug\u00e8ne-d&#039;Argentenay' >Saint-Eug\u00e8ne-d&#039;Argentenay<\/option><option value='Saint-Eug\u00e8ne-de-Guigues' >Saint-Eug\u00e8ne-de-Guigues<\/option><option value='Saint-Eug\u00e8ne-de-Ladri\u00e8re' >Saint-Eug\u00e8ne-de-Ladri\u00e8re<\/option><option value='Saint-Eus\u00e8be' >Saint-Eus\u00e8be<\/option><option value='Saint-Eustache' >Saint-Eustache<\/option><option value='Saint-\u00c9variste-de-Forsyth' >Saint-\u00c9variste-de-Forsyth<\/option><option value='Saint-Fabien' >Saint-Fabien<\/option><option value='Saint-Fabien-de-Panet' >Saint-Fabien-de-Panet<\/option><option value='Saint-Faustin--Lac-Carr\u00e9' >Saint-Faustin&#8211;Lac-Carr\u00e9<\/option><option value='Saint-F\u00e9licien' >Saint-F\u00e9licien<\/option><option value='Saint-F\u00e9lix-d&#039;Otis' >Saint-F\u00e9lix-d&#039;Otis<\/option><option value='Saint-F\u00e9lix-de-Dalquier' >Saint-F\u00e9lix-de-Dalquier<\/option><option value='Saint-F\u00e9lix-de-Kingsey' >Saint-F\u00e9lix-de-Kingsey<\/option><option value='Saint-F\u00e9lix-de-Valois' >Saint-F\u00e9lix-de-Valois<\/option><option value='Saint-Ferdinand' >Saint-Ferdinand<\/option><option value='Saint-Ferr\u00e9ol-les-Neiges' >Saint-Ferr\u00e9ol-les-Neiges<\/option><option value='Saint-Flavien' >Saint-Flavien<\/option><option value='Saint-Fortunat' >Saint-Fortunat<\/option><option value='Saint-Fran\u00e7ois-Xavier-de-Brompton' >Saint-Fran\u00e7ois-Xavier-de-Brompton<\/option><option value='Saint-Fran\u00e7ois-Xavier-de-Viger' >Saint-Fran\u00e7ois-Xavier-de-Viger<\/option><option value='Saint-Fran\u00e7ois-d&#039;Assise' >Saint-Fran\u00e7ois-d&#039;Assise<\/option><option value='Saint-Fran\u00e7ois-de-Sales' >Saint-Fran\u00e7ois-de-Sales<\/option><option value='Saint-Fran\u00e7ois-de-l&#039;\u00cele-d&#039;Orl\u00e9ans' >Saint-Fran\u00e7ois-de-l&#039;\u00cele-d&#039;Orl\u00e9ans<\/option><option value='Saint-Fran\u00e7ois-de-la-Rivi\u00e8re-du-Sud' >Saint-Fran\u00e7ois-de-la-Rivi\u00e8re-du-Sud<\/option><option value='Saint-Fran\u00e7ois-du-Lac' >Saint-Fran\u00e7ois-du-Lac<\/option><option value='Saint-Fr\u00e9d\u00e9ric' >Saint-Fr\u00e9d\u00e9ric<\/option><option value='Saint-Fulgence' >Saint-Fulgence<\/option><option value='Saint-Gabriel' >Saint-Gabriel<\/option><option value='Saint-Gabriel-Lalemant' >Saint-Gabriel-Lalemant<\/option><option value='Saint-Gabriel-de-Brandon' >Saint-Gabriel-de-Brandon<\/option><option value='Saint-Gabriel-de-Rimouski' >Saint-Gabriel-de-Rimouski<\/option><option value='Saint-Gabriel-de-Valcartier' >Saint-Gabriel-de-Valcartier<\/option><option value='Saint-G\u00e9d\u00e9on' >Saint-G\u00e9d\u00e9on<\/option><option value='Saint-G\u00e9d\u00e9on-de-Beauce' >Saint-G\u00e9d\u00e9on-de-Beauce<\/option><option value='Saint-Georges' >Saint-Georges<\/option><option value='Saint-Georges-de-Clarenceville' >Saint-Georges-de-Clarenceville<\/option><option value='Saint-Georges-de-Windsor' >Saint-Georges-de-Windsor<\/option><option value='Saint-G\u00e9rard-Majella' >Saint-G\u00e9rard-Majella<\/option><option value='Saint-Germain' >Saint-Germain<\/option><option value='Saint-Germain-de-Grantham' >Saint-Germain-de-Grantham<\/option><option value='Saint-Gervais' >Saint-Gervais<\/option><option value='Saint-Gilbert' >Saint-Gilbert<\/option><option value='Saint-Gilles' >Saint-Gilles<\/option><option value='Saint-Godefroi' >Saint-Godefroi<\/option><option value='Saint-Guillaume' >Saint-Guillaume<\/option><option value='Saint-Guy' >Saint-Guy<\/option><option value='Saint-Henri' >Saint-Henri<\/option><option value='Saint-Henri-de-Taillon' >Saint-Henri-de-Taillon<\/option><option value='Saint-Herm\u00e9n\u00e9gilde' >Saint-Herm\u00e9n\u00e9gilde<\/option><option value='Saint-Hilaire-de-Dorset' >Saint-Hilaire-de-Dorset<\/option><option value='Saint-Hilarion' >Saint-Hilarion<\/option><option value='Saint-Hippolyte' >Saint-Hippolyte<\/option><option value='Saint-Honor\u00e9' >Saint-Honor\u00e9<\/option><option value='Saint-Honor\u00e9-de-Shenley' >Saint-Honor\u00e9-de-Shenley<\/option><option value='Saint-Honor\u00e9-de-T\u00e9miscouata' >Saint-Honor\u00e9-de-T\u00e9miscouata<\/option><option value='Saint-Hubert-de-Rivi\u00e8re-du-Loup' >Saint-Hubert-de-Rivi\u00e8re-du-Loup<\/option><option value='Saint-Hugues' >Saint-Hugues<\/option><option value='Saint-Hyacinthe' >Saint-Hyacinthe<\/option><option value='Saint-Ignace-de-Loyola' >Saint-Ignace-de-Loyola<\/option><option value='Saint-Ignace-de-Stanbridge' >Saint-Ignace-de-Stanbridge<\/option><option value='Saint-Ir\u00e9n\u00e9e' >Saint-Ir\u00e9n\u00e9e<\/option><option value='Saint-Isidore' >Saint-Isidore<\/option><option value='Saint-Isidore-de-Clifton' >Saint-Isidore-de-Clifton<\/option><option value='Saint-Jacques' >Saint-Jacques<\/option><option value='Saint-Jacques-de-Leeds' >Saint-Jacques-de-Leeds<\/option><option value='Saint-Jacques-le-Majeur-de-Wolfestown' >Saint-Jacques-le-Majeur-de-Wolfestown<\/option><option value='Saint-Jacques-le-Mineur' >Saint-Jacques-le-Mineur<\/option><option value='Saint-Janvier-de-Joly' >Saint-Janvier-de-Joly<\/option><option value='Saint-Jean-Baptiste' >Saint-Jean-Baptiste<\/option><option value='Saint-Jean-Port-Joli' >Saint-Jean-Port-Joli<\/option><option value='Saint-Jean-de-Br\u00e9beuf' >Saint-Jean-de-Br\u00e9beuf<\/option><option value='Saint-Jean-de-Cherbourg' >Saint-Jean-de-Cherbourg<\/option><option value='Saint-Jean-de-Dieu' >Saint-Jean-de-Dieu<\/option><option value='Saint-Jean-de-Matha' >Saint-Jean-de-Matha<\/option><option value='Saint-Jean-de-l&#039;\u00cele-d&#039;Orl\u00e9ans' >Saint-Jean-de-l&#039;\u00cele-d&#039;Orl\u00e9ans<\/option><option value='Saint-Jean-de-la-Lande' >Saint-Jean-de-la-Lande<\/option><option value='Saint-Jean-sur-Richelieu' >Saint-Jean-sur-Richelieu<\/option><option value='Saint-J\u00e9r\u00f4me' >Saint-J\u00e9r\u00f4me<\/option><option value='Saint-Joachim' >Saint-Joachim<\/option><option value='Saint-Joachim-de-Shefford' >Saint-Joachim-de-Shefford<\/option><option value='Saint-Joseph-de-Beauce' >Saint-Joseph-de-Beauce<\/option><option value='Saint-Joseph-de-Coleraine' >Saint-Joseph-de-Coleraine<\/option><option value='Saint-Joseph-de-Kamouraska' >Saint-Joseph-de-Kamouraska<\/option><option value='Saint-Joseph-de-Lepage' >Saint-Joseph-de-Lepage<\/option><option value='Saint-Joseph-de-Sorel' >Saint-Joseph-de-Sorel<\/option><option value='Saint-Joseph-des-\u00c9rables' >Saint-Joseph-des-\u00c9rables<\/option><option value='Saint-Joseph-du-Lac' >Saint-Joseph-du-Lac<\/option><option value='Saint-Jude' >Saint-Jude<\/option><option value='Saint-Jules' >Saint-Jules<\/option><option value='Saint-Julien' >Saint-Julien<\/option><option value='Saint-Just-de-Breteni\u00e8res' >Saint-Just-de-Breteni\u00e8res<\/option><option value='Saint-Juste-du-Lac' >Saint-Juste-du-Lac<\/option><option value='Saint-Justin' >Saint-Justin<\/option><option value='Saint-Lambert' >Saint-Lambert<\/option><option value='Saint-Lambert' >Saint-Lambert<\/option><option value='Saint-Lambert-de-Lauzon' >Saint-Lambert-de-Lauzon<\/option><option value='Saint-Laurent-de-l&#039;\u00cele-d&#039;Orl\u00e9ans' >Saint-Laurent-de-l&#039;\u00cele-d&#039;Orl\u00e9ans<\/option><option value='Saint-Lazare' >Saint-Lazare<\/option><option value='Saint-Lazare-de-Bellechasse' >Saint-Lazare-de-Bellechasse<\/option><option value='Saint-L\u00e9andre' >Saint-L\u00e9andre<\/option><option value='Saint-L\u00e9on-de-Standon' >Saint-L\u00e9on-de-Standon<\/option><option value='Saint-L\u00e9on-le-Grand' >Saint-L\u00e9on-le-Grand<\/option><option value='Saint-L\u00e9on-le-Grand' >Saint-L\u00e9on-le-Grand<\/option><option value='Saint-L\u00e9onard-d&#039;Aston' >Saint-L\u00e9onard-d&#039;Aston<\/option><option value='Saint-L\u00e9onard-de-Portneuf' >Saint-L\u00e9onard-de-Portneuf<\/option><option value='Saint-Liboire' >Saint-Liboire<\/option><option value='Saint-Liguori' >Saint-Liguori<\/option><option value='Saint-Lin--Laurentides' >Saint-Lin&#8211;Laurentides<\/option><option value='Saint-Louis' >Saint-Louis<\/option><option value='Saint-Louis-de-Blandford' >Saint-Louis-de-Blandford<\/option><option value='Saint-Louis-de-Gonzague' >Saint-Louis-de-Gonzague<\/option><option value='Saint-Louis-de-Gonzague' >Saint-Louis-de-Gonzague<\/option><option value='Saint-Louis-de-Gonzague-du-Cap-Tourmente' >Saint-Louis-de-Gonzague-du-Cap-Tourmente<\/option><option value='Saint-Louis-du-Ha! Ha!' >Saint-Louis-du-Ha! Ha!<\/option><option value='Saint-Luc-de-Bellechasse' >Saint-Luc-de-Bellechasse<\/option><option value='Saint-Luc-de-Vincennes' >Saint-Luc-de-Vincennes<\/option><option value='Saint-Lucien' >Saint-Lucien<\/option><option value='Saint-Ludger' >Saint-Ludger<\/option><option value='Saint-Ludger-de-Milot' >Saint-Ludger-de-Milot<\/option><option value='Saint-Magloire' >Saint-Magloire<\/option><option value='Saint-Majorique-de-Grantham' >Saint-Majorique-de-Grantham<\/option><option value='Saint-Malachie' >Saint-Malachie<\/option><option value='Saint-Malo' >Saint-Malo<\/option><option value='Saint-Marc-de-Figuery' >Saint-Marc-de-Figuery<\/option><option value='Saint-Marc-des-Carri\u00e8res' >Saint-Marc-des-Carri\u00e8res<\/option><option value='Saint-Marc-du-Lac-Long' >Saint-Marc-du-Lac-Long<\/option><option value='Saint-Marc-sur-Richelieu' >Saint-Marc-sur-Richelieu<\/option><option value='Saint-Marcel' >Saint-Marcel<\/option><option value='Saint-Marcel-de-Richelieu' >Saint-Marcel-de-Richelieu<\/option><option value='Saint-Marcellin' >Saint-Marcellin<\/option><option value='Saint-Martin' >Saint-Martin<\/option><option value='Saint-Mathias-sur-Richelieu' >Saint-Mathias-sur-Richelieu<\/option><option value='Saint-Mathieu' >Saint-Mathieu<\/option><option value='Saint-Mathieu-d&#039;Harricana' >Saint-Mathieu-d&#039;Harricana<\/option><option value='Saint-Mathieu-de-Beloeil' >Saint-Mathieu-de-Beloeil<\/option><option value='Saint-Mathieu-de-Rioux' >Saint-Mathieu-de-Rioux<\/option><option value='Saint-Mathieu-du-Parc' >Saint-Mathieu-du-Parc<\/option><option value='Saint-Maurice' >Saint-Maurice<\/option><option value='Saint-Maxime-du-Mont-Louis' >Saint-Maxime-du-Mont-Louis<\/option><option value='Saint-M\u00e9dard' >Saint-M\u00e9dard<\/option><option value='Saint-Michel' >Saint-Michel<\/option><option value='Saint-Michel-de-Bellechasse' >Saint-Michel-de-Bellechasse<\/option><option value='Saint-Michel-des-Saints' >Saint-Michel-des-Saints<\/option><option value='Saint-Michel-du-Squatec' >Saint-Michel-du-Squatec<\/option><option value='Saint-Modeste' >Saint-Modeste<\/option><option value='Saint-Mo\u00efse' >Saint-Mo\u00efse<\/option><option value='Saint-Narcisse' >Saint-Narcisse<\/option><option value='Saint-Narcisse-de-Beaurivage' >Saint-Narcisse-de-Beaurivage<\/option><option value='Saint-Narcisse-de-Rimouski' >Saint-Narcisse-de-Rimouski<\/option><option value='Saint-Nazaire' >Saint-Nazaire<\/option><option value='Saint-Nazaire-d&#039;Acton' >Saint-Nazaire-d&#039;Acton<\/option><option value='Saint-Nazaire-de-Dorchester' >Saint-Nazaire-de-Dorchester<\/option><option value='Saint-N\u00e9r\u00e9e-de-Bellechasse' >Saint-N\u00e9r\u00e9e-de-Bellechasse<\/option><option value='Saint-No\u00ebl' >Saint-No\u00ebl<\/option><option value='Saint-Norbert' >Saint-Norbert<\/option><option value='Saint-Norbert-d&#039;Arthabaska' >Saint-Norbert-d&#039;Arthabaska<\/option><option value='Saint-Octave-de-M\u00e9tis' >Saint-Octave-de-M\u00e9tis<\/option><option value='Saint-Odilon-de-Cranbourne' >Saint-Odilon-de-Cranbourne<\/option><option value='Saint-Omer' >Saint-Omer<\/option><option value='Saint-On\u00e9sime-d&#039;Ixworth' >Saint-On\u00e9sime-d&#039;Ixworth<\/option><option value='Saint-Ours' >Saint-Ours<\/option><option value='Saint-Pac\u00f4me' >Saint-Pac\u00f4me<\/option><option value='Saint-Pamphile' >Saint-Pamphile<\/option><option value='Saint-Pascal' >Saint-Pascal<\/option><option value='Saint-Patrice-de-Beaurivage' >Saint-Patrice-de-Beaurivage<\/option><option value='Saint-Patrice-de-Sherrington' >Saint-Patrice-de-Sherrington<\/option><option value='Saint-Paul' >Saint-Paul<\/option><option value='Saint-Paul-d&#039;Abbotsford' >Saint-Paul-d&#039;Abbotsford<\/option><option value='Saint-Paul-de-Montminy' >Saint-Paul-de-Montminy<\/option><option value='Saint-Paul-de-l&#039;\u00cele-aux-Noix' >Saint-Paul-de-l&#039;\u00cele-aux-Noix<\/option><option value='Saint-Paul-de-la-Croix' >Saint-Paul-de-la-Croix<\/option><option value='Saint-Paulin' >Saint-Paulin<\/option><option value='Saint-Phil\u00e9mon' >Saint-Phil\u00e9mon<\/option><option value='Saint-Philibert' >Saint-Philibert<\/option><option value='Saint-Philippe' >Saint-Philippe<\/option><option value='Saint-Philippe-de-N\u00e9ri' >Saint-Philippe-de-N\u00e9ri<\/option><option value='Saint-Pie' >Saint-Pie<\/option><option value='Saint-Pie-de-Guire' >Saint-Pie-de-Guire<\/option><option value='Saint-Pierre' >Saint-Pierre<\/option><option value='Saint-Pierre-Baptiste' >Saint-Pierre-Baptiste<\/option><option value='Saint-Pierre-de-Broughton' >Saint-Pierre-de-Broughton<\/option><option value='Saint-Pierre-de-Lamy' >Saint-Pierre-de-Lamy<\/option><option value='Saint-Pierre-de-l&#039;\u00cele-d&#039;Orl\u00e9ans' >Saint-Pierre-de-l&#039;\u00cele-d&#039;Orl\u00e9ans<\/option><option value='Saint-Pierre-de-la-Rivi\u00e8re-du-Sud' >Saint-Pierre-de-la-Rivi\u00e8re-du-Sud<\/option><option value='Saint-Pierre-les-Becquets' >Saint-Pierre-les-Becquets<\/option><option value='Saint-Placide' >Saint-Placide<\/option><option value='Saint-Polycarpe' >Saint-Polycarpe<\/option><option value='Saint-Prime' >Saint-Prime<\/option><option value='Saint-Prosper' >Saint-Prosper<\/option><option value='Saint-Prosper-de-Champlain' >Saint-Prosper-de-Champlain<\/option><option value='Saint-Rapha\u00ebl' >Saint-Rapha\u00ebl<\/option><option value='Saint-Raymond' >Saint-Raymond<\/option><option value='Saint-R\u00e9mi' >Saint-R\u00e9mi<\/option><option value='Saint-R\u00e9mi-de-Tingwick' >Saint-R\u00e9mi-de-Tingwick<\/option><option value='Saint-Ren\u00e9' >Saint-Ren\u00e9<\/option><option value='Saint-Ren\u00e9-de-Matane' >Saint-Ren\u00e9-de-Matane<\/option><option value='Saint-Robert' >Saint-Robert<\/option><option value='Saint-Robert-Bellarmin' >Saint-Robert-Bellarmin<\/option><option value='Saint-Roch-Ouest' >Saint-Roch-Ouest<\/option><option value='Saint-Roch-de-M\u00e9kinac' >Saint-Roch-de-M\u00e9kinac<\/option><option value='Saint-Roch-de-Richelieu' >Saint-Roch-de-Richelieu<\/option><option value='Saint-Roch-de-l&#039;Achigan' >Saint-Roch-de-l&#039;Achigan<\/option><option value='Saint-Roch-des-Aulnaies' >Saint-Roch-des-Aulnaies<\/option><option value='Saint-Romain' >Saint-Romain<\/option><option value='Saint-Rosaire' >Saint-Rosaire<\/option><option value='Saint-Samuel' >Saint-Samuel<\/option><option value='Saint-Sauveur' >Saint-Sauveur<\/option><option value='Saint-S\u00e9bastien' >Saint-S\u00e9bastien<\/option><option value='Saint-S\u00e9v\u00e8re' >Saint-S\u00e9v\u00e8re<\/option><option value='Saint-S\u00e9verin' >Saint-S\u00e9verin<\/option><option value='Saint-Sim\u00e9on' >Saint-Sim\u00e9on<\/option><option value='Saint-Simon' >Saint-Simon<\/option><option value='Saint-Simon-les-Mines' >Saint-Simon-les-Mines<\/option><option value='Saint-Sixte' >Saint-Sixte<\/option><option value='Saint-Stanislas' >Saint-Stanislas<\/option><option value='Saint-Stanislas-de-Kostka' >Saint-Stanislas-de-Kostka<\/option><option value='Saint-Sulpice' >Saint-Sulpice<\/option><option value='Saint-Sylv\u00e8re' >Saint-Sylv\u00e8re<\/option><option value='Saint-Sylvestre' >Saint-Sylvestre<\/option><option value='Saint-T\u00e9lesphore' >Saint-T\u00e9lesphore<\/option><option value='Saint-Tharcisius' >Saint-Tharcisius<\/option><option value='Saint-Th\u00e9odore-d&#039;Acton' >Saint-Th\u00e9odore-d&#039;Acton<\/option><option value='Saint-Th\u00e9ophile' >Saint-Th\u00e9ophile<\/option><option value='Saint-Thomas' >Saint-Thomas<\/option><option value='Saint-Thomas-Didyme' >Saint-Thomas-Didyme<\/option><option value='Saint-Thuribe' >Saint-Thuribe<\/option><option value='Saint-Tite' >Saint-Tite<\/option><option value='Saint-Tite-des-Caps' >Saint-Tite-des-Caps<\/option><option value='Saint-Ubalde' >Saint-Ubalde<\/option><option value='Saint-Ulric' >Saint-Ulric<\/option><option value='Saint-Valentin' >Saint-Valentin<\/option><option value='Saint-Val\u00e8re' >Saint-Val\u00e8re<\/option><option value='Saint-Val\u00e9rien' >Saint-Val\u00e9rien<\/option><option value='Saint-Val\u00e9rien-de-Milton' >Saint-Val\u00e9rien-de-Milton<\/option><option value='Saint-Vallier' >Saint-Vallier<\/option><option value='Saint-Venant-de-Paquette' >Saint-Venant-de-Paquette<\/option><option value='Saint-Vianney' >Saint-Vianney<\/option><option value='Saint-Victor' >Saint-Victor<\/option><option value='Saint-Wenceslas' >Saint-Wenceslas<\/option><option value='Saint-Zacharie' >Saint-Zacharie<\/option><option value='Saint-Z\u00e9non' >Saint-Z\u00e9non<\/option><option value='Saint-Z\u00e9non-du-Lac-Humqui' >Saint-Z\u00e9non-du-Lac-Humqui<\/option><option value='Saint-Z\u00e9phirin-de-Courval' >Saint-Z\u00e9phirin-de-Courval<\/option><option value='Saint-Zotique' >Saint-Zotique<\/option><option value='Sainte-Ad\u00e8le' >Sainte-Ad\u00e8le<\/option><option value='Sainte-Agathe-de-Lotbini\u00e8re' >Sainte-Agathe-de-Lotbini\u00e8re<\/option><option value='Sainte-Agathe-des-Monts' >Sainte-Agathe-des-Monts<\/option><option value='Sainte-Ang\u00e8le-de-M\u00e9rici' >Sainte-Ang\u00e8le-de-M\u00e9rici<\/option><option value='Sainte-Ang\u00e8le-de-Monnoir' >Sainte-Ang\u00e8le-de-Monnoir<\/option><option value='Sainte-Ang\u00e8le-de-Pr\u00e9mont' >Sainte-Ang\u00e8le-de-Pr\u00e9mont<\/option><option value='Sainte-Anne-de-Beaupr\u00e9' >Sainte-Anne-de-Beaupr\u00e9<\/option><option value='Sainte-Anne-de-Bellevue' >Sainte-Anne-de-Bellevue<\/option><option value='Sainte-Anne-de-Sabrevois' >Sainte-Anne-de-Sabrevois<\/option><option value='Sainte-Anne-de-Sorel' >Sainte-Anne-de-Sorel<\/option><option value='Sainte-Anne-de-la-P\u00e9rade' >Sainte-Anne-de-la-P\u00e9rade<\/option><option value='Sainte-Anne-de-la-Pocati\u00e8re' >Sainte-Anne-de-la-Pocati\u00e8re<\/option><option value='Sainte-Anne-de-la-Rochelle' >Sainte-Anne-de-la-Rochelle<\/option><option value='Sainte-Anne-des-Lacs' >Sainte-Anne-des-Lacs<\/option><option value='Sainte-Anne-des-Monts' >Sainte-Anne-des-Monts<\/option><option value='Sainte-Anne-des-Plaines' >Sainte-Anne-des-Plaines<\/option><option value='Sainte-Anne-du-Lac' >Sainte-Anne-du-Lac<\/option><option value='Sainte-Apolline-de-Patton' >Sainte-Apolline-de-Patton<\/option><option value='Sainte-Aur\u00e9lie' >Sainte-Aur\u00e9lie<\/option><option value='Sainte-Barbe' >Sainte-Barbe<\/option><option value='Sainte-B\u00e9atrix' >Sainte-B\u00e9atrix<\/option><option value='Sainte-Brigide-d&#039;Iberville' >Sainte-Brigide-d&#039;Iberville<\/option><option value='Sainte-Brigitte-de-Laval' >Sainte-Brigitte-de-Laval<\/option><option value='Sainte-Brigitte-des-Saults' >Sainte-Brigitte-des-Saults<\/option><option value='Sainte-Catherine' >Sainte-Catherine<\/option><option value='Sainte-Catherine-de-Hatley' >Sainte-Catherine-de-Hatley<\/option><option value='Sainte-Catherine-de-la-Jacques-Cartier' >Sainte-Catherine-de-la-Jacques-Cartier<\/option><option value='Sainte-C\u00e9cile-de-L\u00e9vrard' >Sainte-C\u00e9cile-de-L\u00e9vrard<\/option><option value='Sainte-C\u00e9cile-de-Milton' >Sainte-C\u00e9cile-de-Milton<\/option><option value='Sainte-C\u00e9cile-de-Whitton' >Sainte-C\u00e9cile-de-Whitton<\/option><option value='Sainte-Christine' >Sainte-Christine<\/option><option value='Sainte-Christine-d&#039;Auvergne' >Sainte-Christine-d&#039;Auvergne<\/option><option value='Sainte-Claire' >Sainte-Claire<\/option><option value='Sainte-Clotilde' >Sainte-Clotilde<\/option><option value='Sainte-Clotilde-de-Beauce' >Sainte-Clotilde-de-Beauce<\/option><option value='Sainte-Clotilde-de-Horton' >Sainte-Clotilde-de-Horton<\/option><option value='Sainte-Croix' >Sainte-Croix<\/option><option value='Sainte-Edwidge-de-Clifton' >Sainte-Edwidge-de-Clifton<\/option><option value='Sainte-\u00c9lisabeth' >Sainte-\u00c9lisabeth<\/option><option value='Sainte-\u00c9lizabeth-de-Warwick' >Sainte-\u00c9lizabeth-de-Warwick<\/option><option value='Sainte-\u00c9m\u00e9lie-de-l&#039;\u00c9nergie' >Sainte-\u00c9m\u00e9lie-de-l&#039;\u00c9nergie<\/option><option value='Sainte-Eulalie' >Sainte-Eulalie<\/option><option value='Sainte-Euph\u00e9mie-sur-Rivi\u00e8re-du-Sud' >Sainte-Euph\u00e9mie-sur-Rivi\u00e8re-du-Sud<\/option><option value='Sainte-Famille-de-l\u2019\u00cele-d\u2019Orl\u00e9ans' >Sainte-Famille-de-l\u2019\u00cele-d\u2019Orl\u00e9ans<\/option><option value='Sainte-F\u00e9licit\u00e9' >Sainte-F\u00e9licit\u00e9<\/option><option value='Sainte-Flavie' >Sainte-Flavie<\/option><option value='Sainte-Florence' >Sainte-Florence<\/option><option value='Sainte-Fran\u00e7oise' >Sainte-Fran\u00e7oise<\/option><option value='Sainte-Fran\u00e7oise' >Sainte-Fran\u00e7oise<\/option><option value='Sainte-Genevi\u00e8ve-de-Batiscan' >Sainte-Genevi\u00e8ve-de-Batiscan<\/option><option value='Sainte-Genevi\u00e8ve-de-Berthier' >Sainte-Genevi\u00e8ve-de-Berthier<\/option><option value='Sainte-Germaine-Boul\u00e9' >Sainte-Germaine-Boul\u00e9<\/option><option value='Sainte-Gertrude-Manneville' >Sainte-Gertrude-Manneville<\/option><option value='Sainte-Hedwidge' >Sainte-Hedwidge<\/option><option value='Sainte-H\u00e9l\u00e8ne-de-Bagot' >Sainte-H\u00e9l\u00e8ne-de-Bagot<\/option><option value='Sainte-H\u00e9l\u00e8ne-de-Chester' >Sainte-H\u00e9l\u00e8ne-de-Chester<\/option><option value='Sainte-H\u00e9l\u00e8ne-de-Kamouraska' >Sainte-H\u00e9l\u00e8ne-de-Kamouraska<\/option><option value='Sainte-H\u00e9l\u00e8ne-de-Mancebourg' >Sainte-H\u00e9l\u00e8ne-de-Mancebourg<\/option><option value='Sainte-H\u00e9n\u00e9dine' >Sainte-H\u00e9n\u00e9dine<\/option><option value='Sainte-Ir\u00e8ne' >Sainte-Ir\u00e8ne<\/option><option value='Sainte-Jeanne-d&#039;Arc' >Sainte-Jeanne-d&#039;Arc<\/option><option value='Sainte-Jeanne-d&#039;Arc' >Sainte-Jeanne-d&#039;Arc<\/option><option value='Sainte-Julie' >Sainte-Julie<\/option><option value='Sainte-Julienne' >Sainte-Julienne<\/option><option value='Sainte-Justine' >Sainte-Justine<\/option><option value='Sainte-Justine-de-Newton' >Sainte-Justine-de-Newton<\/option><option value='Sainte-Louise' >Sainte-Louise<\/option><option value='Sainte-Luce' >Sainte-Luce<\/option><option value='Sainte-Lucie-de-Beauregard' >Sainte-Lucie-de-Beauregard<\/option><option value='Sainte-Lucie-des-Laurentides' >Sainte-Lucie-des-Laurentides<\/option><option value='Sainte-Madeleine' >Sainte-Madeleine<\/option><option value='Sainte-Madeleine-de-la-Rivi\u00e8re-Madeleine' >Sainte-Madeleine-de-la-Rivi\u00e8re-Madeleine<\/option><option value='Sainte-Marcelline-de-Kildare' >Sainte-Marcelline-de-Kildare<\/option><option value='Sainte-Marguerite' >Sainte-Marguerite<\/option><option value='Sainte-Marguerite-Marie' >Sainte-Marguerite-Marie<\/option><option value='Sainte-Marguerite-du-Lac-Masson' >Sainte-Marguerite-du-Lac-Masson<\/option><option value='Sainte-Marie' >Sainte-Marie<\/option><option value='Sainte-Marie-Madeleine' >Sainte-Marie-Madeleine<\/option><option value='Sainte-Marie-Salom\u00e9' >Sainte-Marie-Salom\u00e9<\/option><option value='Sainte-Marie-de-Blandford' >Sainte-Marie-de-Blandford<\/option><option value='Sainte-Marthe' >Sainte-Marthe<\/option><option value='Sainte-Marthe-sur-le-Lac' >Sainte-Marthe-sur-le-Lac<\/option><option value='Sainte-Martine' >Sainte-Martine<\/option><option value='Sainte-M\u00e9lanie' >Sainte-M\u00e9lanie<\/option><option value='Sainte-Monique' >Sainte-Monique<\/option><option value='Sainte-Monique' >Sainte-Monique<\/option><option value='Sainte-Paule' >Sainte-Paule<\/option><option value='Sainte-Perp\u00e9tue' >Sainte-Perp\u00e9tue<\/option><option value='Sainte-P\u00e9tronille' >Sainte-P\u00e9tronille<\/option><option value='Sainte-Prax\u00e8de' >Sainte-Prax\u00e8de<\/option><option value='Sainte-Rita' >Sainte-Rita<\/option><option value='Sainte-Rose-de-Watford' >Sainte-Rose-de-Watford<\/option><option value='Sainte-Rose-du-Nord' >Sainte-Rose-du-Nord<\/option><option value='Sainte-Sabine' >Sainte-Sabine<\/option><option value='Sainte-S\u00e9raphine' >Sainte-S\u00e9raphine<\/option><option value='Sainte-Sophie' >Sainte-Sophie<\/option><option value='Sainte-Sophie-d&#039;Halifax' >Sainte-Sophie-d&#039;Halifax<\/option><option value='Sainte-Sophie-de-L\u00e9vrard' >Sainte-Sophie-de-L\u00e9vrard<\/option><option value='Sainte-Th\u00e8cle' >Sainte-Th\u00e8cle<\/option><option value='Sainte-Th\u00e9r\u00e8se' >Sainte-Th\u00e9r\u00e8se<\/option><option value='Sainte-Th\u00e9r\u00e8se-de-Gasp\u00e9' >Sainte-Th\u00e9r\u00e8se-de-Gasp\u00e9<\/option><option value='Sainte-Th\u00e9r\u00e8se-de-la-Gatineau' >Sainte-Th\u00e9r\u00e8se-de-la-Gatineau<\/option><option value='Sainte-Ursule' >Sainte-Ursule<\/option><option value='Sainte-Victoire-de-Sorel' >Sainte-Victoire-de-Sorel<\/option><option value='Saints-Anges' >Saints-Anges<\/option><option value='Saints-Martyrs-Canadiens' >Saints-Martyrs-Canadiens<\/option><option value='Salaberry-de-Valleyfield' >Salaberry-de-Valleyfield<\/option><option value='Salluit' >Salluit<\/option><option value='Sayabec' >Sayabec<\/option><option value='Schefferville' >Schefferville<\/option><option value='Scotstown' >Scotstown<\/option><option value='Scott' >Scott<\/option><option value='Senneterre' >Senneterre<\/option><option value='Senneville' >Senneville<\/option><option value='Sept-\u00celes' >Sept-\u00celes<\/option><option value='Sept-Rivi\u00e8res' >Sept-Rivi\u00e8res<\/option><option value='Shannon' >Shannon<\/option><option value='Shawinigan' >Shawinigan<\/option><option value='Shawville' >Shawville<\/option><option value='Sheenboro' >Sheenboro<\/option><option value='Shefford' >Shefford<\/option><option value='Sherbrooke' >Sherbrooke<\/option><option value='Shigawake' >Shigawake<\/option><option value='Sorel-Tracy' >Sorel-Tracy<\/option><option value='Stanbridge East' >Stanbridge East<\/option><option value='Stanbridge Station' >Stanbridge Station<\/option><option value='Stanstead' >Stanstead<\/option><option value='Stanstead-Est' >Stanstead-Est<\/option><option value='Stoke' >Stoke<\/option><option value='Stoneham-et-Tewkesbury' >Stoneham-et-Tewkesbury<\/option><option value='Stornoway' >Stornoway<\/option><option value='Stratford' >Stratford<\/option><option value='Stukely-Sud' >Stukely-Sud<\/option><option value='Sutton' >Sutton<\/option><option value='Tadoussac' >Tadoussac<\/option><option value='Taschereau' >Taschereau<\/option><option value='Tasiujaq' >Tasiujaq<\/option><option value='T\u00e9miscaming' >T\u00e9miscaming<\/option><option value='T\u00e9miscamingue' >T\u00e9miscamingue<\/option><option value='T\u00e9miscouata' >T\u00e9miscouata<\/option><option value='T\u00e9miscouata-sur-le-Lac' >T\u00e9miscouata-sur-le-Lac<\/option><option value='Terrasse-Vaudreuil' >Terrasse-Vaudreuil<\/option><option value='Terrebonne' >Terrebonne<\/option><option value='Th\u00e9r\u00e8se-De Blainville' >Th\u00e9r\u00e8se-De Blainville<\/option><option value='Thetford Mines' >Thetford Mines<\/option><option value='Thorne' >Thorne<\/option><option value='Thurso' >Thurso<\/option><option value='Tingwick' >Tingwick<\/option><option value='Tourville' >Tourville<\/option><option value='Tr\u00e9cesson' >Tr\u00e9cesson<\/option><option value='Tr\u00e8s-Saint-R\u00e9dempteur' >Tr\u00e8s-Saint-R\u00e9dempteur<\/option><option value='Tr\u00e8s-Saint-Sacrement' >Tr\u00e8s-Saint-Sacrement<\/option><option value='Tring-Jonction' >Tring-Jonction<\/option><option value='Trois-Pistoles' >Trois-Pistoles<\/option><option value='Trois-Rives' >Trois-Rives<\/option><option value='Trois-Rivi\u00e8res' >Trois-Rivi\u00e8res<\/option><option value='Ulverton' >Ulverton<\/option><option value='Umiujaq' >Umiujaq<\/option><option value='Upton' >Upton<\/option><option value='Val-Alain' >Val-Alain<\/option><option value='Val-Brillant' >Val-Brillant<\/option><option value='Val-David' >Val-David<\/option><option value='Val-Joli' >Val-Joli<\/option><option value='Val-Morin' >Val-Morin<\/option><option value='Val-Racine' >Val-Racine<\/option><option value='Val-Saint-Gilles' >Val-Saint-Gilles<\/option><option value='Val-d&#039;Or' >Val-d&#039;Or<\/option><option value='Val-des-Bois' >Val-des-Bois<\/option><option value='Val-des-Lacs' >Val-des-Lacs<\/option><option value='Val-des-Monts' >Val-des-Monts<\/option><option value='Valcourt' >Valcourt<\/option><option value='Valcourt' >Valcourt<\/option><option value='Vall\u00e9e-Jonction' >Vall\u00e9e-Jonction<\/option><option value='Varennes' >Varennes<\/option><option value='Vaudreuil-Dorion' >Vaudreuil-Dorion<\/option><option value='Vaudreuil-Soulanges' >Vaudreuil-Soulanges<\/option><option value='Vaudreuil-sur-le-Lac' >Vaudreuil-sur-le-Lac<\/option><option value='Venise-en-Qu\u00e9bec' >Venise-en-Qu\u00e9bec<\/option><option value='Verch\u00e8res' >Verch\u00e8res<\/option><option value='Victoriaville' >Victoriaville<\/option><option value='Ville-Marie' >Ville-Marie<\/option><option value='Villeroy' >Villeroy<\/option><option value='Waltham' >Waltham<\/option><option value='Warden' >Warden<\/option><option value='Warwick' >Warwick<\/option><option value='Waskaganish' >Waskaganish<\/option><option value='Waswanipi' >Waswanipi<\/option><option value='Waterloo' >Waterloo<\/option><option value='Waterville' >Waterville<\/option><option value='Weedon' >Weedon<\/option><option value='Wemindji' >Wemindji<\/option><option value='Wentworth' >Wentworth<\/option><option value='Wentworth-Nord' >Wentworth-Nord<\/option><option value='Westbury' >Westbury<\/option><option value='Westmount' >Westmount<\/option><option value='Whapmagoostui' >Whapmagoostui<\/option><option value='Wickham' >Wickham<\/option><option value='Windsor' >Windsor<\/option><option value='Wotton' >Wotton<\/option><option value='Yamachiche' >Yamachiche<\/option><option value='Yamaska' >Yamaska<\/option><\/select><\/div><\/div><fieldset id=\"field_1_29\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1V &#8211; Ville ou village<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_29'><div class='gchoice gchoice_1_29_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.1' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_29_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_29_1' id='label_1_29_1' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1_32' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_2' class='gform_page' data-js='page-field-id-32' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_33\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">2. IDENTIFICATION OF VIOLENCE<\/h3><\/div><div id=\"field_1_34\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">What types of violent behaviour did you experience in this situation?*<\/h3><div class='gsection_description' id='gfield_description_1_34'>You can select more than one option.<\/div><\/div><fieldset id=\"field_1_35\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >2V &#8211; Forme de violence<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_35'><div class='gchoice gchoice_1_35_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.1' type='checkbox'  value='Psychologique ou verbale'  id='choice_1_35_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_35_1' id='label_1_35_1' class='gform-field-label gform-field-label--type-inline'>Psychological or verbal<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_35_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.2' type='checkbox'  value='Physique'  id='choice_1_35_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_35_2' id='label_1_35_2' class='gform-field-label gform-field-label--type-inline'>Physical<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_35_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.3' type='checkbox'  value='Sexuelle'  id='choice_1_35_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_35_3' id='label_1_35_3' class='gform-field-label gform-field-label--type-inline'>Sexual<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_35_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.4' type='checkbox'  value='Cyberviolence'  id='choice_1_35_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_35_4' id='label_1_35_4' class='gform-field-label gform-field-label--type-inline'>Cyberviolence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_35_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.5' type='checkbox'  value='N\u00e9gligence'  id='choice_1_35_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_35_5' id='label_1_35_5' class='gform-field-label gform-field-label--type-inline'>Negligence<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_35_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.6' type='checkbox'  value='En lien avec la religion ou la spiritualit\u00e9'  id='choice_1_35_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_35_6' id='label_1_35_6' class='gform-field-label gform-field-label--type-inline'>Religious or spiritual abuse<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_35_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.7' type='checkbox'  value='\u00c9conomique'  id='choice_1_35_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_35_7' id='label_1_35_7' class='gform-field-label gform-field-label--type-inline'>Financial<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_35_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_35.8' type='checkbox'  value='Syst\u00e9mique'  id='choice_1_35_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_35_8' id='label_1_35_8' class='gform-field-label gform-field-label--type-inline'>Systemic<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='mm_tooltip_text' style='display:none'><hr \/><p>FR : Attitude, parole ou geste qui vise \u00e0 diminuer, voire d\u00e9truire l\u2019estime de soi ou le sentiment de s\u00e9curit\u00e9 d\u2019une autre personne de fa\u00e7on \u00e0 la maintenir en position d\u2019inf\u00e9riorit\u00e9 | EN : Attitude, speech or gesture that aims to diminish or destroy another person\u2019s self-esteem or sense of security in order to keep them in an inferior position<\/p><hr \/><p>FR : Geste impliquant un contact physique avec une personne ou un objet, qui vise \u00e0 blesser, menacer ou faire peur | EN : Gesture involving physical contact with a person or object, intended to injure, threaten or frighten<\/p><hr \/><p>FR : Tout geste \u00e0 caract\u00e8re sexuel non consenti, verbal ou non verbal, isol\u00e9 ou r\u00e9p\u00e9t\u00e9; toute tentative d\u2019acte sexuel ou tout autre acte exerc\u00e9 par autrui contre la sexualit\u00e9 d\u2019une personne en faisant usage de la force, quelle que soit sa relation avec la victime, dans n\u2019importe quel contexte | EN : Any nonconsensual sexual act, verbal or non-verbal, isolated or repeated; any attempt by another person to perform a sexual act or any other act against the sexuality of a person using force, regardless of his or her relationship with the victim, in any context<\/p><hr \/><p>FR : Acte agressif, isol\u00e9 ou r\u00e9p\u00e9t\u00e9, perp\u00e9tr\u00e9 au moyen de m\u00e9dias num\u00e9riques (p. ex. texto, Internet, r\u00e9seaux sociaux, etc.), qui vise \u00e0 blesser, d\u00e9nigrer ou contr\u00f4ler autrui | EN : Aggressive, isolated or repeated act, perpetrated using digital media (e.g. text messages, internet, social networks, etc.) to hurt, denigrate or control others<\/p><hr \/><p>FR : Absence ou manque important de r\u00e9ponse aux besoins d\u2019une personne \u00e0 charge | EN : Failure or significant lack of response to a dependent\u2019s needs<\/p><hr \/><p>FR : Attitude, parole ou geste qui vise \u00e0 d\u00e9nigrer ou contr\u00f4ler les croyances d\u2019une autre personne | EN : Attitude, speech or gesture that is intended to denigrate or control the beliefs of another person<\/p><hr \/><p>FR : Acte qui vise \u00e0 restreindre l\u2019autonomie financi\u00e8re d\u2019une autre personne pour mieux la contr\u00f4ler | EN : Act that seeks to restrict another person\u2019s financial autonomy in order to better control them<\/p><hr \/><p>FR : Violence cr\u00e9e par les dynamiques de pouvoir qui existent au sein de notre soci\u00e9t\u00e9 et qui sont reproduites aux niveaux institutionnel, structurel et interpersonnel (p. ex. domaines du logement, de l\u2019emploi, de la sant\u00e9, de la justice, etc.) | EN : Violence created by power dynamics that exist within our society and are replicated at the institutional, structural and interpersonal levels (e.g., housing, employment, health, justice, etc.)<\/p><\/div><\/fieldset><div id=\"field_1_37\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Psychological or verbal <\/h3><\/div><fieldset id=\"field_1_36\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I was\u2026<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_36'><div class='gchoice gchoice_1_36_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.1' type='checkbox'  value='Des insultes'  id='choice_1_36_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_1' id='label_1_36_1' class='gform-field-label gform-field-label--type-inline'>Insulted<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.2' type='checkbox'  value='Des menaces'  id='choice_1_36_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_2' id='label_1_36_2' class='gform-field-label gform-field-label--type-inline'>Threatened<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.3' type='checkbox'  value='Des mensonges'  id='choice_1_36_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_3' id='label_1_36_3' class='gform-field-label gform-field-label--type-inline'>Lied to<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.4' type='checkbox'  value='Des critiques incessantes'  id='choice_1_36_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_4' id='label_1_36_4' class='gform-field-label gform-field-label--type-inline'>Criticized incessantly<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.5' type='checkbox'  value='Du contr\u00f4le coercitif'  id='choice_1_36_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_5' id='label_1_36_5' class='gform-field-label gform-field-label--type-inline'>Coercitive control<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.6' type='checkbox'  value='Du m\u00e9genrage'  id='choice_1_36_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_6' id='label_1_36_6' class='gform-field-label gform-field-label--type-inline'>Being misgendered or deadnamed<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.7' type='checkbox'  value='De la d\u00e9valorisation'  id='choice_1_36_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_7' id='label_1_36_7' class='gform-field-label gform-field-label--type-inline'>Being devalued, denigrated or belittled<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.8' type='checkbox'  value='De la manipulation'  id='choice_1_36_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_8' id='label_1_36_8' class='gform-field-label gform-field-label--type-inline'>Being manipulated<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.9' type='checkbox'  value='De l\u2019intimidation'  id='choice_1_36_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_9' id='label_1_36_9' class='gform-field-label gform-field-label--type-inline'>Being intimidated<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.11' type='checkbox'  value='De l\u2019humiliation'  id='choice_1_36_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_11' id='label_1_36_11' class='gform-field-label gform-field-label--type-inline'>Being humiliated<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.12' type='checkbox'  value='De l\u2019invalidation'  id='choice_1_36_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_12' id='label_1_36_12' class='gform-field-label gform-field-label--type-inline'>Being invalidated<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.13' type='checkbox'  value='De l\u2019infantilisation'  id='choice_1_36_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_13' id='label_1_36_13' class='gform-field-label gform-field-label--type-inline'>Being infantilized<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.14' type='checkbox'  value='Un isolement social forc\u00e9'  id='choice_1_36_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_14' id='label_1_36_14' class='gform-field-label gform-field-label--type-inline'>Social isolation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.15' type='checkbox'  value='Un d\u00e9voilement non consenti de ma situation ou mon identit\u00e9'  id='choice_1_36_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_15' id='label_1_36_15' class='gform-field-label gform-field-label--type-inline'>Being threatened with or revealing sensitive information<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_36_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_36.16' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_36_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_36_16' id='label_1_36_16' class='gform-field-label gform-field-label--type-inline'>Other(s) (please specify below)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='mm_tooltip_text' style='display:none'><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><p>FR : M\u00e9genrage &#8211; lorsqu\u2019une personne ne respecte pas les pronoms et accords d\u2019une autre personne (p. ex. dire d\u2019une femme \u00ab il est attachant \u00bb plut\u00f4t que \u00ab elle est attachante \u00bb) | EN : Misgendering : when someone doesn&#8217;t respect someone&#8217;s pronouns or gendered terms (i.e. Mister\/Miss, He\/she\/they, etc.)<\/p><hr \/><hr \/><hr \/><hr \/><hr \/><p>FR : Invalidation &#8211; lorsqu\u2019une personne ignore, rejette ou juge les \u00e9motions d\u2019une autre personne, ou impose sa vision des \u00e9motions, du v\u00e9cu ou de l\u2019identit\u00e9 d\u2019une autre personne (p. ex. ne pas croire une personne lorsqu\u2019elle fait son coming out) | EN : Invalidation &#8211;\u00a0 when someone ignores, rejects or judges another person\u2019s emotions, or imposes their view of the emotions, experiences or identity of another person (e.g., not believing a person when they come out)<\/p><hr \/><p>FR : Infantilisation &#8211; lorsqu\u2019une personne se positionne comme sup\u00e9rieure dans le but de d\u00e9valoriser les connaissances, les aptitudes ou les exp\u00e9riences de l\u2019autre (p. ex. dire \u00e0 une personne lesbienne qu\u2019elle finira par reconna\u00eetre les autres femmes lesbiennes quand elle aura assez d\u2019exp\u00e9rience) | EN : Infantilization: when a person positions themself as superior in order to devalue the knowledge, skills or experiences of the other (e.g. tell a lesbian that she will recognize other lesbian women when she has enough experience)<\/p><hr \/><p>FR : Par exemple, lorsqu\u2019une personne emp\u00eache l\u2019autre de voir ou de parler \u00e0 sa famille | EN : For example when someone keep another person from seeing their friends and family.<\/p><hr \/><p>FR : Par exemple, lorsqu\u2019une personne d\u00e9voile l\u2019identit\u00e9 LGBTQI+ ou le statut s\u00e9rologique d\u2019une autre personne sans son consentement | EN : For example, when someone outs someone else as being LGBTQ+.<\/p><\/div><\/fieldset><div id=\"field_1_38\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_38'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_1_38' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_39\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Physical<\/h3><\/div><fieldset id=\"field_1_41\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I was\u2026<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_41'><div class='gchoice gchoice_1_41_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.1' type='checkbox'  value='Un pincement'  id='choice_1_41_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_1' id='label_1_41_1' class='gform-field-label gform-field-label--type-inline'>Pinched<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.2' type='checkbox'  value='Une pouss\u00e9e ou une bousculade'  id='choice_1_41_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_2' id='label_1_41_2' class='gform-field-label gform-field-label--type-inline'>Pushed or shoved<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.3' type='checkbox'  value='Une gifle'  id='choice_1_41_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_3' id='label_1_41_3' class='gform-field-label gform-field-label--type-inline'>Slapped<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.4' type='checkbox'  value='Une br\u00fblure'  id='choice_1_41_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_4' id='label_1_41_4' class='gform-field-label gform-field-label--type-inline'>Burned<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.5' type='checkbox'  value='Un coup de poing ou de pied'  id='choice_1_41_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_5' id='label_1_41_5' class='gform-field-label gform-field-label--type-inline'>Hit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.6' type='checkbox'  value='La restriction de mes mouvements ou on a bloqu\u00e9 mon chemin'  id='choice_1_41_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_6' id='label_1_41_6' class='gform-field-label gform-field-label--type-inline'>Being restricted in movements or someone blocking your way<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.7' type='checkbox'  value='Un \u00e9tranglement ou la restriction de mes voies respiratoires'  id='choice_1_41_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_7' id='label_1_41_7' class='gform-field-label gform-field-label--type-inline'>Restricting your breathing or strangling<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.8' type='checkbox'  value='Une blessure par arme blanche'  id='choice_1_41_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_8' id='label_1_41_8' class='gform-field-label gform-field-label--type-inline'>Being stabbed<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.9' type='checkbox'  value='Une blessure par balle'  id='choice_1_41_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_9' id='label_1_41_9' class='gform-field-label gform-field-label--type-inline'>Being shot<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.11' type='checkbox'  value='Une menace de blessure physique'  id='choice_1_41_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_11' id='label_1_41_11' class='gform-field-label gform-field-label--type-inline'>Being threatened of injury<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.12' type='checkbox'  value='De la pression physique \u00e0 consommer de l\u2019alcool ou de la drogue'  id='choice_1_41_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_12' id='label_1_41_12' class='gform-field-label gform-field-label--type-inline'>Being drugged or forced to drink, or pressured to<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.13' type='checkbox'  value='Une sc\u00e8ne de violence envers un objet'  id='choice_1_41_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_13' id='label_1_41_13' class='gform-field-label gform-field-label--type-inline'>Being the target of thrown objects, seeing objects being thrown or damaged<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.14' type='checkbox'  value='Une tentative de meurtre'  id='choice_1_41_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_14' id='label_1_41_14' class='gform-field-label gform-field-label--type-inline'>Being victim of attempted murder<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_41_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_41.15' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_41_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_41_15' id='label_1_41_15' class='gform-field-label gform-field-label--type-inline'>Other(s) (please specify below)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_40\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_40'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_1_40' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_42\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Sexual<\/h3><\/div><fieldset id=\"field_1_43\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I was\u2026<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_43'><div class='gchoice gchoice_1_43_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.1' type='checkbox'  value='Une remarque \u00e0 caract\u00e8re sexuel non d\u00e9sir\u00e9e'  id='choice_1_43_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_1' id='label_1_43_1' class='gform-field-label gform-field-label--type-inline'>Receiving sexual comments, or unwanted comments on your body<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.2' type='checkbox'  value='Un attouchement non d\u00e9sir\u00e9'  id='choice_1_43_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_2' id='label_1_43_2' class='gform-field-label gform-field-label--type-inline'>Touched without consent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.3' type='checkbox'  value='Du harc\u00e8lement sexuel'  id='choice_1_43_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_3' id='label_1_43_3' class='gform-field-label gform-field-label--type-inline'>Sexually harassed<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.4' type='checkbox'  value='Une pression \u00e0 toucher'  id='choice_1_43_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_4' id='label_1_43_4' class='gform-field-label gform-field-label--type-inline'>Pressured or forced to touch someone<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.5' type='checkbox'  value='Une pression \u00e0 avoir un rapport sexuel'  id='choice_1_43_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_5' id='label_1_43_5' class='gform-field-label gform-field-label--type-inline'>Pressured or forced to have sexual relations<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.6' type='checkbox'  value='Une pression \u00e0 avoir certaines pratiques sexuelles'  id='choice_1_43_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_6' id='label_1_43_6' class='gform-field-label gform-field-label--type-inline'>Pressured or forced to have certain sexual practices<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.7' type='checkbox'  value='Des questions intrusives, par exemple \u00e0 propos de mes organes g\u00e9nitaux'  id='choice_1_43_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_7' id='label_1_43_7' class='gform-field-label gform-field-label--type-inline'>Being asked intrusive questions (ex. about your genitalia)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.8' type='checkbox'  value='Une pression \u00e0 regarder des images sexuellement explicites'  id='choice_1_43_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_8' id='label_1_43_8' class='gform-field-label gform-field-label--type-inline'>Being forced or compelled to look at sexually explicit images<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.9' type='checkbox'  value='Une pression \u00e0 produire des images sexuellement explicites'  id='choice_1_43_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_9' id='label_1_43_9' class='gform-field-label gform-field-label--type-inline'>Being forced or compelled to produce sexually explicit images<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.11' type='checkbox'  value='Le partage d&#039;images intimes de ma personne \u00e0 d&#039;autres sans mon consentement'  id='choice_1_43_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_11' id='label_1_43_11' class='gform-field-label gform-field-label--type-inline'>Intimate personal images being shared with other people without my consent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.12' type='checkbox'  value='Une pression \u00e0 avoir un rapport sexuel sans moyen de protection'  id='choice_1_43_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_12' id='label_1_43_12' class='gform-field-label gform-field-label--type-inline'>Being forced to have sexual intercourse without means of protection<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.13' type='checkbox'  value='De la manipulation dans le but d\u2019influencer le consentement'  id='choice_1_43_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_13' id='label_1_43_13' class='gform-field-label gform-field-label--type-inline'>Being manipulated in order to influence consent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.14' type='checkbox'  value='Le non-d\u00e9voilement d\u2019une infection transmissible sexuellement ou par le sang lorsqu\u2019il y a possibilit\u00e9 de transmission'  id='choice_1_43_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_14' id='label_1_43_14' class='gform-field-label gform-field-label--type-inline'>Being intentionally exposed to a sexually transmitted or blood-borne infection without your knowledge or consent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.15' type='checkbox'  value='Le retrait non consenti du moyen de protection pendant un rapport sexuel'  id='choice_1_43_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_15' id='label_1_43_15' class='gform-field-label gform-field-label--type-inline'>Protection being removed without consent (ex. stealthing)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_43_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.16' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_43_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_43_16' id='label_1_43_16' class='gform-field-label gform-field-label--type-inline'>Other(s) (please specify below)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_44\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_44'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_1_44' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_45\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Cyberviolence<\/h3><\/div><fieldset id=\"field_1_46\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I was\u2026<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_46'><div class='gchoice gchoice_1_46_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.1' type='checkbox'  value='Le vol de mon identit\u00e9 ou de mes mots de passe'  id='choice_1_46_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_1' id='label_1_46_1' class='gform-field-label gform-field-label--type-inline'>Having your identity or password stolen<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.2' type='checkbox'  value='Une atteinte \u00e0 ma r\u00e9putation ou de la diffamation en ligne'  id='choice_1_46_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_2' id='label_1_46_2' class='gform-field-label gform-field-label--type-inline'>Having your reputation damaged online<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.3' type='checkbox'  value='Des propos haineux'  id='choice_1_46_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_3' id='label_1_46_3' class='gform-field-label gform-field-label--type-inline'>Receiving hate speech<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.4' type='checkbox'  value='Des menaces'  id='choice_1_46_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_4' id='label_1_46_4' class='gform-field-label gform-field-label--type-inline'>Receiving threats online<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.5' type='checkbox'  value='L&#039;exposition \u00e0 des messages, images ou contenus haineux envers les communaut\u00e9s LGBTQ+'  id='choice_1_46_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_5' id='label_1_46_5' class='gform-field-label gform-field-label--type-inline'>Seeing messages or images that are hateful to the LGBTQ+ communities<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.6' type='checkbox'  value='De la surveillance ou de l\u2019espionnage'  id='choice_1_46_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_6' id='label_1_46_6' class='gform-field-label gform-field-label--type-inline'>Being watched or spied on<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.7' type='checkbox'  value='La propagation de rumeurs \u00e0 mon \u00e9gard'  id='choice_1_46_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_7' id='label_1_46_7' class='gform-field-label gform-field-label--type-inline'>Having a speech about you circulated without your consent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.8' type='checkbox'  value='La publication ou le partage non consenti(e) de photos ou de vid\u00e9os o\u00f9 j\u2019apparais'  id='choice_1_46_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_8' id='label_1_46_8' class='gform-field-label gform-field-label--type-inline'>Made aware that pictures or videos of me had been shared or posted without my consent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.9' type='checkbox'  value='La divulgation non consentie d&#039;informations sur ma vie priv\u00e9e'  id='choice_1_46_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_9' id='label_1_46_9' class='gform-field-label gform-field-label--type-inline'>Having your personal information seen or shared without your consent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.11' type='checkbox'  value='La consultation non consentie de mes conversations priv\u00e9es'  id='choice_1_46_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_11' id='label_1_46_11' class='gform-field-label gform-field-label--type-inline'>Having your private messages seen or shared without your consent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.12' type='checkbox'  value='Une pression \u00e0 r\u00e9v\u00e9ler des informations priv\u00e9es'  id='choice_1_46_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_12' id='label_1_46_12' class='gform-field-label gform-field-label--type-inline'>Being pressured into sharing your personal informations online<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.13' type='checkbox'  value='Le non-respect de mon identit\u00e9 ou on m&#039;a demand\u00e9 des documents excessifs \u00e0 propos de mon identit\u00e9'  id='choice_1_46_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_13' id='label_1_46_13' class='gform-field-label gform-field-label--type-inline'>Seeing your identity not respected or being unreasonably asked for documentation regarding your identity<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.14' type='checkbox'  value='La perte d&#039;acc\u00e8s \u00e0 un compte \u00e0 cause des r\u00e8gles du site ou de l&#039;application concernant mon identit\u00e9'  id='choice_1_46_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_14' id='label_1_46_14' class='gform-field-label gform-field-label--type-inline'>Losing access to your account because of the rules of a web site regarding your identity<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.15' type='checkbox'  value='Une obligation \u00e0 fournir mes mots de passe ou les acc\u00e8s \u00e0 mes comptes'  id='choice_1_46_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_15' id='label_1_46_15' class='gform-field-label gform-field-label--type-inline'>Being forced to give access to your accounts and passwords<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.16' type='checkbox'  value='Une censure de mes contenus publi\u00e9s sur les r\u00e9seaux sociaux'  id='choice_1_46_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_16' id='label_1_46_16' class='gform-field-label gform-field-label--type-inline'>The content I post online being censored because it was about LGBTQ+ topics<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_46_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_46.17' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_46_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_46_17' id='label_1_46_17' class='gform-field-label gform-field-label--type-inline'>Other(s) (please specify below)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_47\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_47'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_1_47' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_48\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Negligence<\/h3><\/div><fieldset id=\"field_1_49\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I was\u2026<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_49'><div class='gchoice gchoice_1_49_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.1' type='checkbox'  value='Me nourrir suffisamment ou ad\u00e9quatement'  id='choice_1_49_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_49_1' id='label_1_49_1' class='gform-field-label gform-field-label--type-inline'>Not fed sufficiently or decently<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_49_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.2' type='checkbox'  value='Me loger ad\u00e9quatement'  id='choice_1_49_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_49_2' id='label_1_49_2' class='gform-field-label gform-field-label--type-inline'>Not housed suitably<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_49_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.3' type='checkbox'  value='Me fournir les v\u00eatements dont j\u2019ai besoin'  id='choice_1_49_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_49_3' id='label_1_49_3' class='gform-field-label gform-field-label--type-inline'>Not given the clothes I needed <\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_49_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.4' type='checkbox'  value='Me fournir les m\u00e9dicaments dont j&#039;ai besoin'  id='choice_1_49_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_49_4' id='label_1_49_4' class='gform-field-label gform-field-label--type-inline'>Someone neglecting to provide the necessary medication I needed as a dependent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_49_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.5' type='checkbox'  value='Me fournir les soins de sant\u00e9 dont j\u2019ai besoin'  id='choice_1_49_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_49_5' id='label_1_49_5' class='gform-field-label gform-field-label--type-inline'>Someone neglecting to provide the necessary health care I needed as a dependent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_49_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.6' type='checkbox'  value='Me fournir une supervision ad\u00e9quate ou d\u2019assurer ma s\u00e9curit\u00e9'  id='choice_1_49_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_49_6' id='label_1_49_6' class='gform-field-label gform-field-label--type-inline'>Someone neglecting my safety as a dependent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_49_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.7' type='checkbox'  value='R\u00e9pondre \u00e0 mes besoins sociaux et affectifs'  id='choice_1_49_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_49_7' id='label_1_49_7' class='gform-field-label gform-field-label--type-inline'>Someone neglecting to answer to my emotional or social needs as a dependent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_49_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_49.8' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_49_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_49_8' id='label_1_49_8' class='gform-field-label gform-field-label--type-inline'>Other(s) (please specify below)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_50\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_50'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_1_50' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_51\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Religious of spiritual <\/h3><\/div><fieldset id=\"field_1_52\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I was\u2026<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_52'><div class='gchoice gchoice_1_52_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.1' type='checkbox'  value='Une exclusion ou menace d\u2019exclusion d\u2019une communaut\u00e9 religieuse ou spirituelle en raison de mon orientation sexuelle ou mon identit\u00e9 de genre'  id='choice_1_52_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_52_1' id='label_1_52_1' class='gform-field-label gform-field-label--type-inline'>Excluded or threatened to be excluded from a religious or spiritual community because of my sexual orientation or gender identity<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_52_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.2' type='checkbox'  value='Une exclusion ou menace d\u2019exclusion d\u2019un groupe ou d\u2019une activit\u00e9 LGBTQI+ en raison de mes croyances religieuses ou spirituelles'  id='choice_1_52_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_52_2' id='label_1_52_2' class='gform-field-label gform-field-label--type-inline'>Excluded or threatened to be excluded from an LGBTQI+ group or activity because of my religious or spiritual beliefs<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_52_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.3' type='checkbox'  value='Un mariage forc\u00e9'  id='choice_1_52_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_52_3' id='label_1_52_3' class='gform-field-label gform-field-label--type-inline'>In a forced marriage<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_52_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.4' type='checkbox'  value='Une interdiction de mariage'  id='choice_1_52_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_52_4' id='label_1_52_4' class='gform-field-label gform-field-label--type-inline'>Forbidden to marry<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_52_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.5' type='checkbox'  value='Un d\u00e9nigrement de mes croyances religieuses ou spirituelles'  id='choice_1_52_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_52_5' id='label_1_52_5' class='gform-field-label gform-field-label--type-inline'>Denigrated because of my religious or spiritual beliefs<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_52_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.6' type='checkbox'  value='Un d\u00e9nigrement de mon identit\u00e9 LGBTQ+ via l&#039;utilisation de croyances religieuses ou spirituelles'  id='choice_1_52_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_52_6' id='label_1_52_6' class='gform-field-label gform-field-label--type-inline'>Being belittled, discriminated against or threatened, as an LGBTQ+ person by using religious or spiritual beliefs<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_52_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.7' type='checkbox'  value='Une interdiction d\u2019exprimer mes croyances religieuses ou spirituelles'  id='choice_1_52_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_52_7' id='label_1_52_7' class='gform-field-label gform-field-label--type-inline'>Being prevented from practicing religion or chosen spirituality<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_52_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.8' type='checkbox'  value='Une obligation \u00e0 pratiquer une religion ou \u00e0 adopter des pratiques spirituelles'  id='choice_1_52_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_52_8' id='label_1_52_8' class='gform-field-label gform-field-label--type-inline'>Being forced to practice a religion or to make a spiritual journey<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_52_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_52.9' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_52_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_52_9' id='label_1_52_9' class='gform-field-label gform-field-label--type-inline'>Other(s) (please specify below)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_53\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_53'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_1_53' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_54\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Financial<\/h3><\/div><fieldset id=\"field_1_55\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I experienced\u2026<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_55'><div class='gchoice gchoice_1_55_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.1' type='checkbox'  value='Une prise de contr\u00f4le sur mes \u00e9tudes ou mon travail'  id='choice_1_55_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_55_1' id='label_1_55_1' class='gform-field-label gform-field-label--type-inline'>Someone controlling my studies, or my work <\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_55_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.2' type='checkbox'  value='Une prise de contr\u00f4le sur mes revenus'  id='choice_1_55_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_55_2' id='label_1_55_2' class='gform-field-label gform-field-label--type-inline'>Someone controlling my income<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_55_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.3' type='checkbox'  value='Une prise de contr\u00f4le sur mes d\u00e9penses'  id='choice_1_55_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_55_3' id='label_1_55_3' class='gform-field-label gform-field-label--type-inline'>Someone controlling my expenses<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_55_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.4' type='checkbox'  value='Une fraude ou tentative de fraude'  id='choice_1_55_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_55_4' id='label_1_55_4' class='gform-field-label gform-field-label--type-inline'>Fraud or attempted fraud<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_55_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.5' type='checkbox'  value='Un vol d\u2019identit\u00e9'  id='choice_1_55_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_55_5' id='label_1_55_5' class='gform-field-label gform-field-label--type-inline'>Identity theft<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_55_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.6' type='checkbox'  value='Une pression \u00e0 m\u2019endetter'  id='choice_1_55_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_55_6' id='label_1_55_6' class='gform-field-label gform-field-label--type-inline'>Pressure to be in debt<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_55_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.7' type='checkbox'  value='Une interdiction d\u2019achats essentiels'  id='choice_1_55_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_55_7' id='label_1_55_7' class='gform-field-label gform-field-label--type-inline'>Not being allowed to buy essential things<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_55_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.8' type='checkbox'  value='Une obligation \u00e0 voler ou frauder'  id='choice_1_55_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_55_8' id='label_1_55_8' class='gform-field-label gform-field-label--type-inline'>An obligation to steal or defraud<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_55_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.9' type='checkbox'  value='La d\u00e9t\u00e9rioration ou destruction de mes biens'  id='choice_1_55_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_55_9' id='label_1_55_9' class='gform-field-label gform-field-label--type-inline'>The destruction or damage of my things<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_55_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.11' type='checkbox'  value='Un vol'  id='choice_1_55_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_55_11' id='label_1_55_11' class='gform-field-label gform-field-label--type-inline'>A theft<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_55_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.12' type='checkbox'  value='Une introduction par effraction'  id='choice_1_55_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_55_12' id='label_1_55_12' class='gform-field-label gform-field-label--type-inline'>Being a victim of breaking and entering<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_55_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.13' type='checkbox'  value='Une incitation ou pression \u00e0 effectuer certains achats'  id='choice_1_55_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_55_13' id='label_1_55_13' class='gform-field-label gform-field-label--type-inline'>Pressure to buy certain things<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_55_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.14' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_55_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_55_14' id='label_1_55_14' class='gform-field-label gform-field-label--type-inline'>Other(s) (Please specify)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='mm_tooltip_text' style='display:none'><hr \/><hr \/><hr \/><hr \/><p>FR : Par exemple, utiliser la carte de cr\u00e9dit d\u2019une autre personne sans son consentement | EN : For example, using someone else&#8217;s credit card without their consent<\/p><\/div><\/fieldset><div id=\"field_1_56\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_56'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_1_56' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_57\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Systemic<\/h3><\/div><fieldset id=\"field_1_58\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >I was\u2026<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_58'><div class='gchoice gchoice_1_58_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.1' type='checkbox'  value='Un refus d\u2019acc\u00e8s \u00e0 un emploi'  id='choice_1_58_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_58_1' id='label_1_58_1' class='gform-field-label gform-field-label--type-inline'>Refused access to employment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_58_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.2' type='checkbox'  value='Un refus d\u2019acc\u00e8s \u00e0 un logement'  id='choice_1_58_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_58_2' id='label_1_58_2' class='gform-field-label gform-field-label--type-inline'>Refused access to housing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_58_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.3' type='checkbox'  value='Un refus d\u2019acc\u00e8s \u00e0 un service priv\u00e9'  id='choice_1_58_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_58_3' id='label_1_58_3' class='gform-field-label gform-field-label--type-inline'>Refused access to private services<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_58_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.4' type='checkbox'  value='Un refus d\u2019acc\u00e8s \u00e0 un service public'  id='choice_1_58_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_58_4' id='label_1_58_4' class='gform-field-label gform-field-label--type-inline'>Refused access to public services<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_58_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.5' type='checkbox'  value='Un refus d\u2019acc\u00e8s \u00e0 un traitement'  id='choice_1_58_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_58_5' id='label_1_58_5' class='gform-field-label gform-field-label--type-inline'>Refused access to treatments<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_58_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.6' type='checkbox'  value='Une pression ou obligation \u00e0 recourir \u00e0 un traitement'  id='choice_1_58_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_58_6' id='label_1_58_6' class='gform-field-label gform-field-label--type-inline'>Pressured or obligated to take a treatment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_58_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.7' type='checkbox'  value='Un refus d\u2019acc\u00e8s \u00e0 un lieu'  id='choice_1_58_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_58_7' id='label_1_58_7' class='gform-field-label gform-field-label--type-inline'>Refused access to a place<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_58_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.8' type='checkbox'  value='Une n\u00e9gligence ou un non-respect de mes droits humains'  id='choice_1_58_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_58_8' id='label_1_58_8' class='gform-field-label gform-field-label--type-inline'>Neglected or disrespected in regards of my human rights<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_58_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.9' type='checkbox'  value='Une invisibilisation'  id='choice_1_58_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_58_9' id='label_1_58_9' class='gform-field-label gform-field-label--type-inline'>Invisibilized<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_58_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.11' type='checkbox'  value='De la discrimination en raison de mon identit\u00e9 ou de mon apparence'  id='choice_1_58_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_58_11' id='label_1_58_11' class='gform-field-label gform-field-label--type-inline'>Discriminated against because of my identity or my appearance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_58_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.12' type='checkbox'  value='Un service de moindre qualit\u00e9 en raison de mon identit\u00e9 (ethnoculturelle, sexuelle, de genre, etc.) ou de mon apparence'  id='choice_1_58_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_58_12' id='label_1_58_12' class='gform-field-label gform-field-label--type-inline'>Given a lesser service because of my identity or my appearance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_58_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.13' type='checkbox'  value='Une loi discriminatoire (pr\u00e9ciser)'  id='choice_1_58_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_58_13' id='label_1_58_13' class='gform-field-label gform-field-label--type-inline'>A victim of a discriminatory law (Please specify)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_58_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_58.14' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_58_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_58_14' id='label_1_58_14' class='gform-field-label gform-field-label--type-inline'>Other(s) (Please specify)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='mm_tooltip_text' style='display:none'><hr \/><hr \/><hr \/><hr \/><hr \/><p>FR : Par exemple, m\u00e9dicaments anti-VIH, hormones, hospitalisation, etc. | EN : For example, anti-HIV medications, hormones, hospital stay, etc.\u00a0<\/p><hr \/><p>FR : Par exemple, st\u00e9rilisation forc\u00e9e, chirurgie non consentie, th\u00e9rapie de conversion, etc. | EN : For example, forced sterilization, unconsented surgery, conversion therapy, etc.<\/p><hr \/><p>FR : Par exemple, vestiaires, toilettes, etc. | EN : For example bathrooms, changing rooms,\u00a0 etc.<\/p><hr \/><p>FR : Par exemple, traitement d\u00e9favorable sur la base d\u2019un motif de discrimination interdit par la Charte des droits et libert\u00e9s (p. ex. \u00e2ge, sexe, identit\u00e9 de genre, orientation sexuelle, etc.) | EN : For example, Unfavourable treatment on the basis of a ground of discrimination prohibited by the Charter of Rights and Freedoms (e.g. age, gender, gender identity, sexual orientation, etc.)<\/p><hr \/><p>FR : Par exemple, un formulaire ne reconnaissant que le mod\u00e8le familial h\u00e9t\u00e9rosexuel | EN : For example, a form that recognizes only the heterosexual family model<\/p><\/div><\/fieldset><div id=\"field_1_191\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_191'>A discriminatory law<\/label><div class='ginput_container ginput_container_text'><input name='input_191' id='input_1_191' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_59\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_59'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_1_59' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_60' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_1_60' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_3' class='gform_page' data-js='page-field-id-60' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_69\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">3. FREQUENCY<\/h3><\/div><div id=\"field_1_61\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Was the violence you&#039;ve experienced an isolated situation or one that lasted?*<\/h3><\/div><fieldset id=\"field_1_169\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >3V &#8211; Situation isol\u00e9e ou durable<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_169'>\n\t\t\t<div class='gchoice gchoice_1_169_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_169' type='radio' value='Situation isol\u00e9e'  id='choice_1_169_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_169_0' id='label_1_169_0' class='gform-field-label gform-field-label--type-inline'>Isolated situation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_169_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_169' type='radio' value='Situation durable'  id='choice_1_169_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_169_1' id='label_1_169_1' class='gform-field-label gform-field-label--type-inline'>Extended situation<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_68\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">When did this event occur? <\/h3><\/div><div id=\"field_1_175\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_175'>Year<\/label><div class='ginput_container ginput_container_select'><select name='input_175' id='input_1_175' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='2030' >2030<\/option><option value='2029' >2029<\/option><option value='2028' >2028<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><option value='1919' >1919<\/option><option value='1918' >1918<\/option><option value='1917' >1917<\/option><option value='1916' >1916<\/option><option value='1915' >1915<\/option><option value='1914' >1914<\/option><option value='1913' >1913<\/option><option value='1912' >1912<\/option><option value='1911' >1911<\/option><option value='1910' >1910<\/option><option value='1909' >1909<\/option><option value='1908' >1908<\/option><option value='1907' >1907<\/option><option value='1906' >1906<\/option><option value='1905' >1905<\/option><option value='1904' >1904<\/option><option value='1903' >1903<\/option><option value='1902' >1902<\/option><option value='1901' >1901<\/option><option value='1900' >1900<\/option><\/select><\/div><\/div><fieldset id=\"field_1_178\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3V &#8211; Situation isol\u00e9e, Ann\u00e9e<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_178'><div class='gchoice gchoice_1_178_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_178.1' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_178_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_178_1' id='label_1_178_1' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_178_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_178.2' type='checkbox'  value='Je ne sais pas'  id='choice_1_178_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_178_2' id='label_1_178_2' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_71\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_71'>Month<\/label><div class='ginput_container ginput_container_select'><select name='input_71' id='input_1_71' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Janvier' >January<\/option><option value='F\u00e9vrier' >February<\/option><option value='Mars' >March<\/option><option value='Avril' >April<\/option><option value='Mai' >May<\/option><option value='Juin' >June<\/option><option value='Juillet' >July<\/option><option value='Ao\u00fbt' >August<\/option><option value='Septembre' >September<\/option><option value='Octobre' >October<\/option><option value='Novembre' >November<\/option><option value='D\u00e9cembre' >December<\/option><\/select><\/div><\/div><fieldset id=\"field_1_72\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3V &#8211; Situation isol\u00e9e, mois<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_72'><div class='gchoice gchoice_1_72_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.1' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_72_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_72_1' id='label_1_72_1' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_72_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_72.2' type='checkbox'  value='Je ne sais pas'  id='choice_1_72_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_72_2' id='label_1_72_2' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_77\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">During what time of the day did it occur?<\/h3><\/div><fieldset id=\"field_1_78\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3V &#8211; Situation isol\u00e9e, Moment de la journ\u00e9e<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_78'><div class='gchoice gchoice_1_78_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.1' type='checkbox'  value='Jour'  id='choice_1_78_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_78_1' id='label_1_78_1' class='gform-field-label gform-field-label--type-inline'>The day<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_78_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.2' type='checkbox'  value='Soir'  id='choice_1_78_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_78_2' id='label_1_78_2' class='gform-field-label gform-field-label--type-inline'>The evening<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_78_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.3' type='checkbox'  value='Nuit'  id='choice_1_78_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_78_3' id='label_1_78_3' class='gform-field-label gform-field-label--type-inline'>The night<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_78_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.4' type='checkbox'  value='Je ne sais pas'  id='choice_1_78_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_78_4' id='label_1_78_4' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_78_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_78.5' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_78_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_78_5' id='label_1_78_5' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_79\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">How long did this situation last? <\/h3><\/div><fieldset id=\"field_1_90\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >3V &#8211; Situation durable, Pendant combien de temps<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_90'>\n\t\t\t<div class='gchoice gchoice_1_90_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='Des jours'  id='choice_1_90_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_90_0' id='label_1_90_0' class='gform-field-label gform-field-label--type-inline'>Days<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_90_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='Des semaines'  id='choice_1_90_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_90_1' id='label_1_90_1' class='gform-field-label gform-field-label--type-inline'>Weeks<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_90_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='Des mois'  id='choice_1_90_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_90_2' id='label_1_90_2' class='gform-field-label gform-field-label--type-inline'>Months<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_90_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='Des ann\u00e9es'  id='choice_1_90_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_90_3' id='label_1_90_3' class='gform-field-label gform-field-label--type-inline'>Years<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_90_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_90' type='radio' value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_90_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_90_4' id='label_1_90_4' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_73\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">When did you first experience this violence or abuse?<\/h3><\/div><div id=\"field_1_174\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_174'>Year<\/label><div class='ginput_container ginput_container_select'><select name='input_174' id='input_1_174' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='2030' >2030<\/option><option value='2029' >2029<\/option><option value='2028' >2028<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><option value='1919' >1919<\/option><option value='1918' >1918<\/option><option value='1917' >1917<\/option><option value='1916' >1916<\/option><option value='1915' >1915<\/option><option value='1914' >1914<\/option><option value='1913' >1913<\/option><option value='1912' >1912<\/option><option value='1911' >1911<\/option><option value='1910' >1910<\/option><option value='1909' >1909<\/option><option value='1908' >1908<\/option><option value='1907' >1907<\/option><option value='1906' >1906<\/option><option value='1905' >1905<\/option><option value='1904' >1904<\/option><option value='1903' >1903<\/option><option value='1902' >1902<\/option><option value='1901' >1901<\/option><option value='1900' >1900<\/option><\/select><\/div><\/div><fieldset id=\"field_1_179\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3V &#8211; Situation durable, D\u00e9but, Ann\u00e9e<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_179'><div class='gchoice gchoice_1_179_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_179.1' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_179_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_179_1' id='label_1_179_1' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_179_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_179.2' type='checkbox'  value='Je ne sais pas'  id='choice_1_179_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_179_2' id='label_1_179_2' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_75\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_75'>Month<\/label><div class='ginput_container ginput_container_select'><select name='input_75' id='input_1_75' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Janvier' >January<\/option><option value='F\u00e9vrier' >February<\/option><option value='Mars' >March<\/option><option value='Avril' >April<\/option><option value='Mai' >May<\/option><option value='Juin' >June<\/option><option value='Juillet' >July<\/option><option value='Ao\u00fbt' >August<\/option><option value='September' >September<\/option><option value='Octobre' >October<\/option><option value='Novembre' >November<\/option><option value='D\u00e9cembre' >December<\/option><\/select><\/div><\/div><fieldset id=\"field_1_76\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3V &#8211; Situation durable, D\u00e9but, mois<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_76'><div class='gchoice gchoice_1_76_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.1' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_76_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_76_1' id='label_1_76_1' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_76_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.2' type='checkbox'  value='Je ne sais pas'  id='choice_1_76_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_76_2' id='label_1_76_2' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_81\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Is it still ongoing? <\/h3><\/div><fieldset id=\"field_1_88\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >3V &#8211; Situation durable, Toujours en cours?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_88'>\n\t\t\t<div class='gchoice gchoice_1_88_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='Oui'  id='choice_1_88_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_88_0' id='label_1_88_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_88_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='Non'  id='choice_1_88_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_88_1' id='label_1_88_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_88_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_88' type='radio' value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_88_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_88_2' id='label_1_88_2' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_83\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">When did the violence or abuse stop? <\/h3><\/div><div id=\"field_1_176\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_176'>Year<\/label><div class='ginput_container ginput_container_select'><select name='input_176' id='input_1_176' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='2030' >2030<\/option><option value='2029' >2029<\/option><option value='2028' >2028<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><option value='1919' >1919<\/option><option value='1918' >1918<\/option><option value='1917' >1917<\/option><option value='1916' >1916<\/option><option value='1915' >1915<\/option><option value='1914' >1914<\/option><option value='1913' >1913<\/option><option value='1912' >1912<\/option><option value='1911' >1911<\/option><option value='1910' >1910<\/option><option value='1909' >1909<\/option><option value='1908' >1908<\/option><option value='1907' >1907<\/option><option value='1906' >1906<\/option><option value='1905' >1905<\/option><option value='1904' >1904<\/option><option value='1903' >1903<\/option><option value='1902' >1902<\/option><option value='1901' >1901<\/option><option value='1900' >1900<\/option><\/select><\/div><\/div><fieldset id=\"field_1_184\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3V &#8211; Situation durable, Fin, Ann\u00e9e<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_184'><div class='gchoice gchoice_1_184_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_184.1' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_184_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_184_1' id='label_1_184_1' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_184_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_184.2' type='checkbox'  value='Je ne sais pas'  id='choice_1_184_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_184_2' id='label_1_184_2' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_86\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_86'>Month<\/label><div class='ginput_container ginput_container_select'><select name='input_86' id='input_1_86' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Janvier' >January<\/option><option value='F\u00e9vrier' >February<\/option><option value='Mars' >March<\/option><option value='Avril' >April<\/option><option value='Mai' >May<\/option><option value='Juin' >June<\/option><option value='Juillet' >July<\/option><option value='Ao\u00fbt' >August<\/option><option value='Septembre' >September<\/option><option value='Octobre' >October<\/option><option value='Novembre' >November<\/option><option value='D\u00e9cembre' >December<\/option><\/select><\/div><\/div><fieldset id=\"field_1_84\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >3V &#8211; Situation durable, Fin, Mois<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_84'><div class='gchoice gchoice_1_84_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.1' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_84_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_84_1' id='label_1_84_1' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_84_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_84.2' type='checkbox'  value='Je ne sais pas'  id='choice_1_84_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_84_2' id='label_1_84_2' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_87\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Do you feel at risk of experiencing the same situation again or a similar situation?*<\/h3><\/div><fieldset id=\"field_1_89\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >3V &#8211; Revivre la situation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_89'>\n\t\t\t<div class='gchoice gchoice_1_89_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='Oui'  id='choice_1_89_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_89_0' id='label_1_89_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_89_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='Non'  id='choice_1_89_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_89_1' id='label_1_89_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_89_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='Je ne sais pas'  id='choice_1_89_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_89_2' id='label_1_89_2' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_89_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_89' type='radio' value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_89_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_89_3' id='label_1_89_3' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_92\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full alix-color field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_92'>Can you tell us a little more about the risk of experiencing this situation again?<\/label><div class='gfield_description' id='gfield_description_1_92'>Feel free to fill this field or not. Please note that there are no restrictions or word limits. You can upload an audio file in the language you prefer between French, English or Spanish.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_92' id='input_1_92' class='textarea large'  aria-describedby=\"gfield_description_1_92\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_93\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_1_93'>Audio File<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_93' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_93&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_93&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_93&quot;,&quot;filelist&quot;:&quot;gform_preview_1_93&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/alix.interligne.co\\\/en\\\/?gf_page=ed246411945de4e&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/alix.interligne.co\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/alix.interligne.co\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;mp3&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:93,&quot;_gform_file_upload_nonce_1_93&quot;:&quot;bf8a8931c4&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;5&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_1_93&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_93' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_1_93' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_1_93\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_93'>Accepted file types: mp3, Max. file size: 10 MB, Max. files: 5.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_1_93'><\/ul> <div id='gform_preview_1_93' class='ginput_preview_list'><\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_95' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_1_95' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_4' class='gform_page' data-js='page-field-id-95' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_96\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">4. PLACE<\/h3><\/div><div id=\"field_1_97\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Identify the place(s) where you experienced violence or abuse.*<\/h3><div class='gsection_description' id='gfield_description_1_97'>You can select more than one answer <\/div><\/div><fieldset id=\"field_1_98\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4V &#8211; Lieu de la violence<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_98'><div class='gchoice gchoice_1_98_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.1' type='checkbox'  value='Chez moi'  id='choice_1_98_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_1' id='label_1_98_1' class='gform-field-label gform-field-label--type-inline'>At home<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.2' type='checkbox'  value='Chez la ou les personne(s) auteure(s) de la violence'  id='choice_1_98_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_2' id='label_1_98_2' class='gform-field-label gform-field-label--type-inline'>At the perpetrator&#8217;s or perpetrators&#8217; home<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.3' type='checkbox'  value='Autre domicile priv\u00e9'  id='choice_1_98_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_3' id='label_1_98_3' class='gform-field-label gform-field-label--type-inline'>At another private home<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.4' type='checkbox'  value='Au t\u00e9l\u00e9phone'  id='choice_1_98_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_4' id='label_1_98_4' class='gform-field-label gform-field-label--type-inline'>On the phone<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.5' type='checkbox'  value='Milieu de travail'  id='choice_1_98_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_5' id='label_1_98_5' class='gform-field-label gform-field-label--type-inline'>Work environment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.6' type='checkbox'  value='Internet et r\u00e9seaux sociaux (messages priv\u00e9s)'  id='choice_1_98_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_6' id='label_1_98_6' class='gform-field-label gform-field-label--type-inline'>Internet and social media (private messages)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.7' type='checkbox'  value='Internet et r\u00e9seaux sociaux (messages publics)'  id='choice_1_98_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_7' id='label_1_98_7' class='gform-field-label gform-field-label--type-inline'>Internet and social media (public messages)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.8' type='checkbox'  value='Section des commentaires d\u2019un site Web'  id='choice_1_98_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_8' id='label_1_98_8' class='gform-field-label gform-field-label--type-inline'>Comments section of a web site<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.9' type='checkbox'  value='Transports en commun'  id='choice_1_98_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_9' id='label_1_98_9' class='gform-field-label gform-field-label--type-inline'>Public transport <\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.11' type='checkbox'  value='Rue ou parc'  id='choice_1_98_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_11' id='label_1_98_11' class='gform-field-label gform-field-label--type-inline'>Street or park<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.12' type='checkbox'  value='Commerce'  id='choice_1_98_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_12' id='label_1_98_12' class='gform-field-label gform-field-label--type-inline'>Store<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.13' type='checkbox'  value='\u00c9tablissement d\u2019enseignement'  id='choice_1_98_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_13' id='label_1_98_13' class='gform-field-label gform-field-label--type-inline'>Educational institution<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.14' type='checkbox'  value='H\u00f4pital'  id='choice_1_98_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_14' id='label_1_98_14' class='gform-field-label gform-field-label--type-inline'>Hospital<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.15' type='checkbox'  value='CLSC, CISSS, CIUSSS, CHSLD'  id='choice_1_98_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_15' id='label_1_98_15' class='gform-field-label gform-field-label--type-inline'>CLSC, CISSS, CIUSSS, CHSLD<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.16' type='checkbox'  value='Ressource d\u2019h\u00e9bergement'  id='choice_1_98_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_16' id='label_1_98_16' class='gform-field-label gform-field-label--type-inline'>Accommodation resource<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.17' type='checkbox'  value='Ressource communautaire'  id='choice_1_98_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_17' id='label_1_98_17' class='gform-field-label gform-field-label--type-inline'>Community resource<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.18' type='checkbox'  value='Prison ou p\u00e9nitencier'  id='choice_1_98_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_18' id='label_1_98_18' class='gform-field-label gform-field-label--type-inline'>Prison or penitentiary <\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.19' type='checkbox'  value='Poste de police'  id='choice_1_98_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_19' id='label_1_98_19' class='gform-field-label gform-field-label--type-inline'>Police station<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.21' type='checkbox'  value='Base militaire'  id='choice_1_98_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_21' id='label_1_98_21' class='gform-field-label gform-field-label--type-inline'>Military institution <\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.22' type='checkbox'  value='Autre institution gouvernementale (pr\u00e9ciser)'  id='choice_1_98_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_22' id='label_1_98_22' class='gform-field-label gform-field-label--type-inline'>Other government institution (Please specify the institution below)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.23' type='checkbox'  value='M\u00e9dias de masse'  id='choice_1_98_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_23' id='label_1_98_23' class='gform-field-label gform-field-label--type-inline'>Mass Media<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_98_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_98.24' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_98_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_98_24' id='label_1_98_24' class='gform-field-label gform-field-label--type-inline'>Other(s) (please specify below)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='mm_tooltip_text' style='display:none'><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><p>FR : Par exemple,\u00a0 journal, t\u00e9l\u00e9vision, radio, etc. | EN : For example, TV, radio, newspapers, etc.\u00a0<\/p><\/div><\/fieldset><div id=\"field_1_194\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_194'>Other government institution (Please specify the institution below)<\/label><div class='ginput_container ginput_container_text'><input name='input_194' id='input_1_194' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_99\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_99'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_99' id='input_1_99' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_100\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Where did you experience violence or abuse?  <\/h3><\/div><div id=\"field_1_107\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Country*<\/h3><\/div><div id=\"field_1_101\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_101'>4V &#8211; R\u00e9gion de la violence, Pays<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_101' id='input_1_101' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Afrique du Sud' >South Africa<\/option><option value='Albanie' >Albania<\/option><option value='Alg\u00e9rie' >Algeria<\/option><option value='Allemagne' >Germany<\/option><option value='Andorre' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Antigua-et-Barbuda' >Antigua and Barbuda<\/option><option value='Arabie Saoudite' >Saudi Arabia<\/option><option value='Argentine' >Argentina<\/option><option value='Arm\u00e9nie' >Armenia<\/option><option value='Australia' >Australia<\/option><option value='Autriche' >Austria<\/option><option value='Azerba\u00efdjan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahre\u00efn' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbade' >Barbados<\/option><option value='Bi\u00e9lorussie' >Belarus<\/option><option value='Belgique' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='B\u00e9nin' >Benin<\/option><option value='Bhoutan' >Bhutan<\/option><option value='Bolivie' >Bolivia<\/option><option value='Bosnie-Herz\u00e9govine' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Brunei' >Brunei<\/option><option value='Br\u00e9sil' >Brazil<\/option><option value='Bulgarie' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodge' >Cambodia<\/option><option value='Cameroun' >Cameroon<\/option><option value='Canada' selected='selected'>Canada<\/option><option value='Cap-Vert' >Cabo Verde<\/option><option value='Chili' >Chile<\/option><option value='Chine' >China<\/option><option value='Chypre' >Cyprus<\/option><option value='Colombie' >Colombia<\/option><option value='Comores' >Comoros<\/option><option value='Cor\u00e9e du Nord' >North Korea<\/option><option value='Cor\u00e9e du Sud' >South Korea<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatie' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='C\u00f4te d\u2019Ivoire' >Cote d&#039;Ivoire<\/option><option value='Danemark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominique' >Dominica<\/option><option value='\u00c9gypte' >Egypt<\/option><option value='\u00c9mirats arabes unis' >United Arab Emirates<\/option><option value='\u00c9quateur' >Ecuador<\/option><option value='\u00c9rythr\u00e9e' >Eritrea<\/option><option value='Espagne' >Spain<\/option><option value='Estonie' >Estonia<\/option><option value='Eswatini (Swaziland)' >Eswatini (Swaziland)<\/option><option value='\u00c9tats-Unis' >United States<\/option><option value='\u00c9thiopie' >Ethiopia<\/option><option value='Fidji' >Fiji<\/option><option value='Finlande' >Finland<\/option><option value='France' >France<\/option><option value='Gabon' >Gabon<\/option><option value='Gambie' >Gambia<\/option><option value='G\u00e9orgie' >Georgia<\/option><option value='Ghana' >Ghana<\/option><option value='Grenade' >Grenada<\/option><option value='Gr\u00e8ce' >Greece<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guin\u00e9e' >Guinea<\/option><option value='Guin\u00e9e \u00e9quatoriale' >Equatorial Guinea<\/option><option value='Guin\u00e9e-Bissau' >Guinea-Bissau<\/option><option value='Guyane' >Guyana<\/option><option value='Ha\u00efti' >Haiti<\/option><option value='Honduras' >Honduras<\/option><option value='Hongrie' >Hungary<\/option><option value='\u00celes Cook' >Cook Islands<\/option><option value='\u00celes Marshall' >Marshall Islands<\/option><option value='\u00celes Salomon' >Solomon Islands<\/option><option value='Inde' >India<\/option><option value='Indon\u00e9sie' >Indonesia<\/option><option value='Irak' >Iraq<\/option><option value='Iran' >Iran<\/option><option value='Irlande' >Ireland<\/option><option value='Islande' >Iceland<\/option><option value='Isra\u00ebl' >Israel<\/option><option value='Italie' >Italy<\/option><option value='Jama\u00efque' >Jamaica<\/option><option value='Japon' >Japan<\/option><option value='Jordanie' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kirghizistan' >Kyrgyzstan<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kosovo' >Kosovo<\/option><option value='Kowe\u00eft' >Kuwait<\/option><option value='Lesotho' >Lesotho<\/option><option value='Lettonie' >Latvia<\/option><option value='Liban' >Lebanon<\/option><option value='Liberia' >Liberia<\/option><option value='Libye' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituanie' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malaisie' >Malaysia<\/option><option value='Malawi' >Malawi<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malte' >Malta<\/option><option value='Maroc' >Morocco<\/option><option value='Maurice' >Mauritius<\/option><option value='Mauritanie' >Mauritania<\/option><option value='Mexique' >Mexico<\/option><option value='Micron\u00e9sie' >Micronesia<\/option><option value='Moldavie' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolie' >Mongolia<\/option><option value='Mont\u00e9n\u00e9gro' >Montenegro<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibie' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nig\u00e9ria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norv\u00e8ge' >Norway<\/option><option value='Nouvelle-Z\u00e9lande' >New Zealand<\/option><option value='N\u00e9pal' >Nepal<\/option><option value='Oman' >Oman<\/option><option value='Ouganda' >Ouganda<\/option><option value='Ouzb\u00e9kistan' >Uzbekistan<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine' >Palestine<\/option><option value='Panama' >Panama<\/option><option value='Papouasie-Nouvelle-Guin\u00e9e' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Pays-Bas' >Netherlands<\/option><option value='Philippines' >Philippines<\/option><option value='Pologne' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='P\u00e9rou' >Peru<\/option><option value='Qatar' >Qatar<\/option><option value='R\u00e9publique Dominicaine' >Dominican Republic<\/option><option value='R\u00e9publique centrafricaine' >Central African Republic<\/option><option value='R\u00e9publique du Congo' >Congo, Republic of the<\/option><option value='R\u00e9publique d\u00e9mocratique du Congo' >Congo, Democratic Republic of<\/option><option value='R\u00e9publique d\u00e9mocratique populaire du Laos' >Laos<\/option><option value='Roumanie' >Romania<\/option><option value='Royaume-Uni' >United Kingdom<\/option><option value='Russie' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint-Christophe-et-Nevis' >Saint Kitts and Nevis<\/option><option value='Saint-Marin' >Saint Marin<\/option><option value='Saint-Vincent-et-les Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Sainte-Lucie' >Saint Lucia<\/option><option value='Salvador' >El Salvador<\/option><option value='Samoa' >Samoa<\/option><option value='Sao Tom\u00e9 et Principe' >Sao Tome and Principe<\/option><option value='Serbie' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapour' >Singapore<\/option><option value='Slovaquie' >Slovakia<\/option><option value='Slov\u00e9nie' >Slovenia<\/option><option value='Somalie' >Somalia<\/option><option value='Soudan' >Sudan<\/option><option value='Soudan du Sud' >Sudan, South<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Suisse' >Switzerland<\/option><option value='Suriname' >Suriname<\/option><option value='Su\u00e8de' >Sweden<\/option><option value='Syrie' >Syria<\/option><option value='S\u00e9n\u00e9gal' >Senegal<\/option><option value='Ta\u00efwan' >Taiwan<\/option><option value='Tadjikistan' >Tadjikistan<\/option><option value='Tanzanie' >Tanzania<\/option><option value='Tchad' >Chad<\/option><option value='Tch\u00e9quie' >Czechia<\/option><option value='Tha\u00eflande' >Thailand<\/option><option value='Timor oriental' >East Timor (Timor-Leste)<\/option><option value='Togo' >Togo<\/option><option value='Tonga' >Tonga<\/option><option value='Trinit\u00e9 et Tobago' >Trinidad and Tobago<\/option><option value='Tunisie' >Tunisia<\/option><option value='Turkm\u00e9nistan' >Turmekistan<\/option><option value='Turquie' >Turkey<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Ukraine' >Ukraine<\/option><option value='Uruguay' >Uruguay<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Vatican' >Vatican City<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Y\u00e9men' >Yemen<\/option><option value='Zambie' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select><\/div><\/div><div id=\"field_1_108\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Province or territory<\/h3><\/div><div id=\"field_1_103\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_103'>4V &#8211; R\u00e9gion de la violence, Province<\/label><div class='ginput_container ginput_container_select'><select name='input_103' id='input_1_103' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Alberta' >Alberta<\/option><option value='Colombie-Britannique' >British Columbia<\/option><option value='Manitoba' >Manitoba<\/option><option value='Nouveau-Brunswick' >New Brunswick<\/option><option value='Terre-Neuve-et-Labrador' >Newfoundland and Labrador<\/option><option value='Territoires du Nord-Ouest' >Northwest Territories<\/option><option value='Nouvelle-\u00c9cosse' >Nova Scotia<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='\u00cele du Prince-\u00c9douard' >Prince Edward Island<\/option><option value='Qu\u00e9bec' >Quebec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select><\/div><\/div><fieldset id=\"field_1_104\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4V &#8211; R\u00e9gion de la violence, Province<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_104'><div class='gchoice gchoice_1_104_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_104.1' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_104_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_104_1' id='label_1_104_1' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_109\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">City or town<\/h3><\/div><div id=\"field_1_102\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_102'>4V &#8211; R\u00e9gion de la violence, Ville<\/label><div class='ginput_container ginput_container_select'><select name='input_102' id='input_1_102' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Abercorn' >Abercorn<\/option><option value='Abitibi' >Abitibi<\/option><option value='Abitibi-Ouest' >Abitibi-Ouest<\/option><option value='Acton' >Acton<\/option><option value='Acton Vale' >Acton Vale<\/option><option value='Adstock' >Adstock<\/option><option value='Aguanish' >Aguanish<\/option><option value='Akulivik' >Akulivik<\/option><option value='Albanel' >Albanel<\/option><option value='Albertville' >Albertville<\/option><option value='Alleyn-et-Cawood' >Alleyn-et-Cawood<\/option><option value='Alma' >Alma<\/option><option value='Amherst' >Amherst<\/option><option value='Amos' >Amos<\/option><option value='Amqui' >Amqui<\/option><option value='Ange-Gardien' >Ange-Gardien<\/option><option value='Antoine-Labelle' >Antoine-Labelle<\/option><option value='Argenteuil' >Argenteuil<\/option><option value='Armagh' >Armagh<\/option><option value='Arthabaska' >Arthabaska<\/option><option value='Arundel' >Arundel<\/option><option value='Asbestos' >Asbestos<\/option><option value='Ascot Corner' >Ascot Corner<\/option><option value='Aston-Jonction' >Aston-Jonction<\/option><option value='Auclair' >Auclair<\/option><option value='Audet' >Audet<\/option><option value='Aumond' >Aumond<\/option><option value='Aupaluk' >Aupaluk<\/option><option value='Austin' >Austin<\/option><option value='Authier' >Authier<\/option><option value='Authier-Nord' >Authier-Nord<\/option><option value='Avignon' >Avignon<\/option><option value='Ayer&#039;s Cliff' >Ayer&#039;s Cliff<\/option><option value='Baie-Comeau' >Baie-Comeau<\/option><option value='Baie-D&#039;Urf\u00e9' >Baie-D&#039;Urf\u00e9<\/option><option value='Baie-Johan-Beetz' >Baie-Johan-Beetz<\/option><option value='Baie-Saint-Paul' >Baie-Saint-Paul<\/option><option value='Baie-Sainte-Catherine' >Baie-Sainte-Catherine<\/option><option value='Baie-Trinit\u00e9' >Baie-Trinit\u00e9<\/option><option value='Baie-des-Sables' >Baie-des-Sables<\/option><option value='Baie-du-Febvre' >Baie-du-Febvre<\/option><option value='Barkmere' >Barkmere<\/option><option value='Barnston-Ouest' >Barnston-Ouest<\/option><option value='Barraute' >Barraute<\/option><option value='Batiscan' >Batiscan<\/option><option value='Batiscan' >Batiscan<\/option><option value='B\u00e9arn' >B\u00e9arn<\/option><option value='Beauce-Sartigan' >Beauce-Sartigan<\/option><option value='Beauceville' >Beauceville<\/option><option value='Beauharnois' >Beauharnois<\/option><option value='Beauharnois-Salaberry' >Beauharnois-Salaberry<\/option><option value='Beaulac-Garthby' >Beaulac-Garthby<\/option><option value='Beaumont' >Beaumont<\/option><option value='Beaupr\u00e9' >Beaupr\u00e9<\/option><option value='B\u00e9cancour' >B\u00e9cancour<\/option><option value='B\u00e9cancour' >B\u00e9cancour<\/option><option value='Bedford' >Bedford<\/option><option value='B\u00e9gin' >B\u00e9gin<\/option><option value='Belcourt' >Belcourt<\/option><option value='Bellechasse' >Bellechasse<\/option><option value='Belleterre' >Belleterre<\/option><option value='Beloeil' >Beloeil<\/option><option value='Berry' >Berry<\/option><option value='Berthier-sur-Mer' >Berthier-sur-Mer<\/option><option value='Berthierville' >Berthierville<\/option><option value='B\u00e9thanie' >B\u00e9thanie<\/option><option value='Biencourt' >Biencourt<\/option><option value='Blainville' >Blainville<\/option><option value='Blanc-Sablon' >Blanc-Sablon<\/option><option value='Blue Sea' >Blue Sea<\/option><option value='Boileau' >Boileau<\/option><option value='Bois-Franc' >Bois-Franc<\/option><option value='Bois-des-Filion' >Bois-des-Filion<\/option><option value='Boisbriand' >Boisbriand<\/option><option value='Boischatel' >Boischatel<\/option><option value='Bolton-Est' >Bolton-Est<\/option><option value='Bolton-Ouest' >Bolton-Ouest<\/option><option value='Bonaventure' >Bonaventure<\/option><option value='Bonne-Esp\u00e9rance' >Bonne-Esp\u00e9rance<\/option><option value='Bonsecours' >Bonsecours<\/option><option value='Boucherville' >Boucherville<\/option><option value='Bouchette' >Bouchette<\/option><option value='Bowman' >Bowman<\/option><option value='Br\u00e9beuf' >Br\u00e9beuf<\/option><option value='Brigham' >Brigham<\/option><option value='Bristol' >Bristol<\/option><option value='Brome' >Brome<\/option><option value='Brome-Missisquoi' >Brome-Missisquoi<\/option><option value='Bromont' >Bromont<\/option><option value='Brossard' >Brossard<\/option><option value='Brownsburg-Chatham' >Brownsburg-Chatham<\/option><option value='Bryson' >Bryson<\/option><option value='Bury' >Bury<\/option><option value='Cacouna' >Cacouna<\/option><option value='Calixa-Lavall\u00e9e' >Calixa-Lavall\u00e9e<\/option><option value='Campbell&#039;s Bay' >Campbell&#039;s Bay<\/option><option value='Candiac' >Candiac<\/option><option value='Caniapiscau' >Caniapiscau<\/option><option value='Cantley' >Cantley<\/option><option value='Cap-Chat' >Cap-Chat<\/option><option value='Cap-Saint-Ignace' >Cap-Saint-Ignace<\/option><option value='Cap-Sant\u00e9' >Cap-Sant\u00e9<\/option><option value='Caplan' >Caplan<\/option><option value='Carignan' >Carignan<\/option><option value='Carleton-sur-Mer' >Carleton-sur-Mer<\/option><option value='Cascap\u00e9dia--Saint-Jules' >Cascap\u00e9dia&#8211;Saint-Jules<\/option><option value='Causapscal' >Causapscal<\/option><option value='Cayamant' >Cayamant<\/option><option value='Chambly' >Chambly<\/option><option value='Chambord' >Chambord<\/option><option value='Champlain' >Champlain<\/option><option value='Champneuf' >Champneuf<\/option><option value='Chandler' >Chandler<\/option><option value='Chapais' >Chapais<\/option><option value='Charette' >Charette<\/option><option value='Charlemagne' >Charlemagne<\/option><option value='Charlevoix' >Charlevoix<\/option><option value='Charlevoix-Est' >Charlevoix-Est<\/option><option value='Chartierville' >Chartierville<\/option><option value='Ch\u00e2teau-Richer' >Ch\u00e2teau-Richer<\/option><option value='Ch\u00e2teauguay' >Ch\u00e2teauguay<\/option><option value='Chazel' >Chazel<\/option><option value='Chelsea' >Chelsea<\/option><option value='Ch\u00e9n\u00e9ville' >Ch\u00e9n\u00e9ville<\/option><option value='Chertsey' >Chertsey<\/option><option value='Chesterville' >Chesterville<\/option><option value='Chibougamau' >Chibougamau<\/option><option value='Chichester' >Chichester<\/option><option value='Chisasibi' >Chisasibi<\/option><option value='Chute-Saint-Philippe' >Chute-Saint-Philippe<\/option><option value='Chute-aux-Outardes' >Chute-aux-Outardes<\/option><option value='Clarendon' >Clarendon<\/option><option value='Clermont' >Clermont<\/option><option value='Clermont' >Clermont<\/option><option value='Clerval' >Clerval<\/option><option value='Cleveland' >Cleveland<\/option><option value='Cloridorme' >Cloridorme<\/option><option value='Coaticook' >Coaticook<\/option><option value='Colombier' >Colombier<\/option><option value='Compton' >Compton<\/option><option value='Contrec\u0153ur' >Contrec\u0153ur<\/option><option value='Cookshire-Eaton' >Cookshire-Eaton<\/option><option value='C\u00f4te-Nord-du-Golfe-du-Saint-Laurent' >C\u00f4te-Nord-du-Golfe-du-Saint-Laurent<\/option><option value='C\u00f4te-Saint-Luc' >C\u00f4te-Saint-Luc<\/option><option value='Coteau-du-Lac' >Coteau-du-Lac<\/option><option value='Courcelles' >Courcelles<\/option><option value='Cowansville' >Cowansville<\/option><option value='Crabtree' >Crabtree<\/option><option value='D&#039;Autray' >D&#039;Autray<\/option><option value='Danville' >Danville<\/option><option value='Daveluyville' >Daveluyville<\/option><option value='D\u00e9gelis' >D\u00e9gelis<\/option><option value='D\u00e9l\u00e9age' >D\u00e9l\u00e9age<\/option><option value='Delson' >Delson<\/option><option value='Denholm' >Denholm<\/option><option value='Desbiens' >Desbiens<\/option><option value='Deschaillons-sur-Saint-Laurent' >Deschaillons-sur-Saint-Laurent<\/option><option value='Deschambault-Grondines' >Deschambault-Grondines<\/option><option value='Deux-Montagnes' >Deux-Montagnes<\/option><option value='Disraeli' >Disraeli<\/option><option value='Dixville' >Dixville<\/option><option value='Dolbeau-Mistassini' >Dolbeau-Mistassini<\/option><option value='Dollard-Des Ormeaux' >Dollard-Des Ormeaux<\/option><option value='Donnacona' >Donnacona<\/option><option value='Dorval' >Dorval<\/option><option value='Dosquet' >Dosquet<\/option><option value='Drummond' >Drummond<\/option><option value='Drummondville' >Drummondville<\/option><option value='Dudswell' >Dudswell<\/option><option value='Duhamel' >Duhamel<\/option><option value='Duhamel-Ouest' >Duhamel-Ouest<\/option><option value='Dundee' >Dundee<\/option><option value='Dunham' >Dunham<\/option><option value='Duparquet' >Duparquet<\/option><option value='Dupuy' >Dupuy<\/option><option value='Durham-Sud' >Durham-Sud<\/option><option value='East Angus' >East Angus<\/option><option value='East Broughton' >East Broughton<\/option><option value='East Farnham' >East Farnham<\/option><option value='East Hereford' >East Hereford<\/option><option value='Eastmain' >Eastmain<\/option><option value='Eastman' >Eastman<\/option><option value='Eeyou-Istchee Baie-James' >Eeyou-Istchee Baie-James<\/option><option value='Egan-Sud' >Egan-Sud<\/option><option value='Elgin' >Elgin<\/option><option value='Entrelacs' >Entrelacs<\/option><option value='Escuminac' >Escuminac<\/option><option value='Esprit-Saint' >Esprit-Saint<\/option><option value='Est\u00e9rel' >Est\u00e9rel<\/option><option value='Farnham' >Farnham<\/option><option value='Fassett' >Fassett<\/option><option value='Ferland-et-Boilleau' >Ferland-et-Boilleau<\/option><option value='Ferme-Neuve' >Ferme-Neuve<\/option><option value='Fermont' >Fermont<\/option><option value='Forestville' >Forestville<\/option><option value='Fort-Coulonge' >Fort-Coulonge<\/option><option value='Fortierville' >Fortierville<\/option><option value='Fossambault-sur-le-Lac' >Fossambault-sur-le-Lac<\/option><option value='Frampton' >Frampton<\/option><option value='Franklin' >Franklin<\/option><option value='Franquelin' >Franquelin<\/option><option value='Frelighsburg' >Frelighsburg<\/option><option value='Frontenac' >Frontenac<\/option><option value='Fug\u00e8reville' >Fug\u00e8reville<\/option><option value='Gallichan' >Gallichan<\/option><option value='Gasp\u00e9' >Gasp\u00e9<\/option><option value='Gatineau' >Gatineau<\/option><option value='Girardville' >Girardville<\/option><option value='Godbout' >Godbout<\/option><option value='Godmanchester' >Godmanchester<\/option><option value='Gore' >Gore<\/option><option value='Gracefield' >Gracefield<\/option><option value='Granby' >Granby<\/option><option value='Grand-M\u00e9tis' >Grand-M\u00e9tis<\/option><option value='Grand-Remous' >Grand-Remous<\/option><option value='Grand-Saint-Esprit' >Grand-Saint-Esprit<\/option><option value='Grande-Rivi\u00e8re' >Grande-Rivi\u00e8re<\/option><option value='Grande-Vall\u00e9e' >Grande-Vall\u00e9e<\/option><option value='Grandes-Piles' >Grandes-Piles<\/option><option value='Grenville' >Grenville<\/option><option value='Grenville-sur-la-Rouge' >Grenville-sur-la-Rouge<\/option><option value='Gros-M\u00e9catina' >Gros-M\u00e9catina<\/option><option value='Grosse-\u00cele' >Grosse-\u00cele<\/option><option value='Grosses-Roches' >Grosses-Roches<\/option><option value='Gu\u00e9rin' >Gu\u00e9rin<\/option><option value='Ham Sud' >Ham Sud<\/option><option value='Ham-Nord' >Ham-Nord<\/option><option value='Hampden' >Hampden<\/option><option value='Hampstead' >Hampstead<\/option><option value='Harrington' >Harrington<\/option><option value='Hatley' >Hatley<\/option><option value='Havelock' >Havelock<\/option><option value='Havre-Saint-Pierre' >Havre-Saint-Pierre<\/option><option value='H\u00e9bertville' >H\u00e9bertville<\/option><option value='H\u00e9bertville-Station' >H\u00e9bertville-Station<\/option><option value='Hemmingford' >Hemmingford<\/option><option value='Henryville' >Henryville<\/option><option value='H\u00e9rouxville' >H\u00e9rouxville<\/option><option value='Hinchinbrooke' >Hinchinbrooke<\/option><option value='Honfleur' >Honfleur<\/option><option value='Hope' >Hope<\/option><option value='Hope Town' >Hope Town<\/option><option value='Howick' >Howick<\/option><option value='Huberdeau' >Huberdeau<\/option><option value='Hudson' >Hudson<\/option><option value='Huntingdon' >Huntingdon<\/option><option value='Inukjuak' >Inukjuak<\/option><option value='Inverness' >Inverness<\/option><option value='Irlande' >Irlande<\/option><option value='Ivry-sur-le-Lac' >Ivry-sur-le-Lac<\/option><option value='Ivujivik' >Ivujivik<\/option><option value='Joliette' >Joliette<\/option><option value='Kamouraska' >Kamouraska<\/option><option value='Kangiqsualujjuaq' >Kangiqsualujjuaq<\/option><option value='Kangiqsujuaq' >Kangiqsujuaq<\/option><option value='Kangirsuk' >Kangirsuk<\/option><option value='Kawawachikamach' >Kawawachikamach<\/option><option value='Kazabazua' >Kazabazua<\/option><option value='Kiamika' >Kiamika<\/option><option value='Kingsbury' >Kingsbury<\/option><option value='Kingsey Falls' >Kingsey Falls<\/option><option value='Kinnear&#039;s Mills' >Kinnear&#039;s Mills<\/option><option value='Kipawa' >Kipawa<\/option><option value='Kirkland' >Kirkland<\/option><option value='Kuujjuaq' >Kuujjuaq<\/option><option value='Kuujjuarapik' >Kuujjuarapik<\/option><option value='L&#039;Ancienne-Lorette' >L&#039;Ancienne-Lorette<\/option><option value='L&#039;Ange-Gardien' >L&#039;Ange-Gardien<\/option><option value='L&#039;Anse-Saint-Jean' >L&#039;Anse-Saint-Jean<\/option><option value='L&#039;Ascension' >L&#039;Ascension<\/option><option value='L&#039;Ascension-de-Notre-Seigneur' >L&#039;Ascension-de-Notre-Seigneur<\/option><option value='L&#039;Ascension-de-Patap\u00e9dia' >L&#039;Ascension-de-Patap\u00e9dia<\/option><option value='L&#039;Assomption' >L&#039;Assomption<\/option><option value='L&#039;Assomption' >L&#039;Assomption<\/option><option value='L&#039;Avenir' >L&#039;Avenir<\/option><option value='L&#039;\u00c9piphanie' >L&#039;\u00c9piphanie<\/option><option value='L&#039;\u00c9rable' >L&#039;\u00c9rable<\/option><option value='L&#039;\u00cele-Cadieux' >L&#039;\u00cele-Cadieux<\/option><option value='L&#039;\u00cele-Dorval' >L&#039;\u00cele-Dorval<\/option><option value='L&#039;\u00cele-Perrot' >L&#039;\u00cele-Perrot<\/option><option value='L&#039;\u00cele-d&#039;Anticosti' >L&#039;\u00cele-d&#039;Anticosti<\/option><option value='L&#039;\u00cele-d&#039;Orl\u00e9ans' >L&#039;\u00cele-d&#039;Orl\u00e9ans<\/option><option value='L&#039;\u00cele-du-Grand-Calumet' >L&#039;\u00cele-du-Grand-Calumet<\/option><option value='L&#039;Isle-Verte' >L&#039;Isle-Verte<\/option><option value='L&#039;Isle-aux-Allumettes' >L&#039;Isle-aux-Allumettes<\/option><option value='L&#039;Isle-aux-Coudres' >L&#039;Isle-aux-Coudres<\/option><option value='L&#039;Islet' >L&#039;Islet<\/option><option value='La Bostonnais' >La Bostonnais<\/option><option value='La Conception' >La Conception<\/option><option value='La Corne' >La Corne<\/option><option value='La C\u00f4te-de-Beaupr\u00e9' >La C\u00f4te-de-Beaupr\u00e9<\/option><option value='La C\u00f4te-de-Gasp\u00e9' >La C\u00f4te-de-Gasp\u00e9<\/option><option value='La Dor\u00e9' >La Dor\u00e9<\/option><option value='La Durantaye' >La Durantaye<\/option><option value='La Guadeloupe' >La Guadeloupe<\/option><option value='La Haute-C\u00f4te-Nord' >La Haute-C\u00f4te-Nord<\/option><option value='La Haute-Gasp\u00e9sie' >La Haute-Gasp\u00e9sie<\/option><option value='La Haute-Yamaska' >La Haute-Yamaska<\/option><option value='La Jacques-Cartier' >La Jacques-Cartier<\/option><option value='La Macaza' >La Macaza<\/option><option value='La Malbaie' >La Malbaie<\/option><option value='La Martre' >La Martre<\/option><option value='La Matanie' >La Matanie<\/option><option value='La Matap\u00e9dia' >La Matap\u00e9dia<\/option><option value='La Minerve' >La Minerve<\/option><option value='La Mitis' >La Mitis<\/option><option value='La Morandi\u00e8re' >La Morandi\u00e8re<\/option><option value='La Motte' >La Motte<\/option><option value='La Nouvelle-Beauce' >La Nouvelle-Beauce<\/option><option value='La Patrie' >La Patrie<\/option><option value='La P\u00eache' >La P\u00eache<\/option><option value='La Pocati\u00e8re' >La Pocati\u00e8re<\/option><option value='La Prairie' >La Prairie<\/option><option value='La Pr\u00e9sentation' >La Pr\u00e9sentation<\/option><option value='La R\u00e9demption' >La R\u00e9demption<\/option><option value='La Reine' >La Reine<\/option><option value='La Rivi\u00e8re-du-Nord' >La Rivi\u00e8re-du-Nord<\/option><option value='La Sarre' >La Sarre<\/option><option value='La Trinit\u00e9-des-Monts' >La Trinit\u00e9-des-Monts<\/option><option value='La Tuque' >La Tuque<\/option><option value='La Vall\u00e9e-de-l&#039;Or' >La Vall\u00e9e-de-l&#039;Or<\/option><option value='La Vall\u00e9e-de-la-Gatineau' >La Vall\u00e9e-de-la-Gatineau<\/option><option value='La Vall\u00e9e-du-Richelieu' >La Vall\u00e9e-du-Richelieu<\/option><option value='La Visitation-de-Yamaska' >La Visitation-de-Yamaska<\/option><option value='La Visitation-de-l&#039;\u00cele-Dupas' >La Visitation-de-l&#039;\u00cele-Dupas<\/option><option value='Labelle' >Labelle<\/option><option value='Labrecque' >Labrecque<\/option><option value='Lac-Beauport' >Lac-Beauport<\/option><option value='Lac-Bouchette' >Lac-Bouchette<\/option><option value='Lac-Brome' >Lac-Brome<\/option><option value='Lac-Delage' >Lac-Delage<\/option><option value='Lac-Drolet' >Lac-Drolet<\/option><option value='Lac-\u00c9douard' >Lac-\u00c9douard<\/option><option value='Lac-Etchemin' >Lac-Etchemin<\/option><option value='Lac-Fronti\u00e8re' >Lac-Fronti\u00e8re<\/option><option value='Lac-M\u00e9gantic' >Lac-M\u00e9gantic<\/option><option value='Lac-Poulin' >Lac-Poulin<\/option><option value='Lac-Saguay' >Lac-Saguay<\/option><option value='Lac-Saint-Jean-Est' >Lac-Saint-Jean-Est<\/option><option value='Lac-Saint-Joseph' >Lac-Saint-Joseph<\/option><option value='Lac-Saint-Paul' >Lac-Saint-Paul<\/option><option value='Lac-Sainte-Marie' >Lac-Sainte-Marie<\/option><option value='Lac-Sergent' >Lac-Sergent<\/option><option value='Lac-Simon' >Lac-Simon<\/option><option value='Lac-Sup\u00e9rieur' >Lac-Sup\u00e9rieur<\/option><option value='Lac-Tremblant-Nord' >Lac-Tremblant-Nord<\/option><option value='Lac-au-Saumon' >Lac-au-Saumon<\/option><option value='Lac-aux-Sables' >Lac-aux-Sables<\/option><option value='Lac-des-Aigles' >Lac-des-Aigles<\/option><option value='Lac-des-\u00c9corces' >Lac-des-\u00c9corces<\/option><option value='Lac-des-Plages' >Lac-des-Plages<\/option><option value='Lac-des-Seize-\u00celes' >Lac-des-Seize-\u00celes<\/option><option value='Lac-du-Cerf' >Lac-du-Cerf<\/option><option value='Lachute' >Lachute<\/option><option value='Lacolle' >Lacolle<\/option><option value='Laforce' >Laforce<\/option><option value='Lamarche' >Lamarche<\/option><option value='Lambton' >Lambton<\/option><option value='Landrienne' >Landrienne<\/option><option value='Lanoraie' >Lanoraie<\/option><option value='Lantier' >Lantier<\/option><option value='Larouche' >Larouche<\/option><option value='Latulipe-et-Gaboury' >Latulipe-et-Gaboury<\/option><option value='Launay' >Launay<\/option><option value='Laurier-Station' >Laurier-Station<\/option><option value='Laurierville' >Laurierville<\/option><option value='Laval' >Laval<\/option><option value='Lavaltrie' >Lavaltrie<\/option><option value='Laverloch\u00e8re Angliers' >Laverloch\u00e8re Angliers<\/option><option value='Lawrenceville' >Lawrenceville<\/option><option value='Le Domaine-du-Roy' >Le Domaine-du-Roy<\/option><option value='Le Fjord-du-Saguenay' >Le Fjord-du-Saguenay<\/option><option value='Le Golfe-du-Saint-Laurent' >Le Golfe-du-Saint-Laurent<\/option><option value='Le Granit' >Le Granit<\/option><option value='Le Haut-Richelieu' >Le Haut-Richelieu<\/option><option value='Le Haut-Saint-Fran\u00e7ois' >Le Haut-Saint-Fran\u00e7ois<\/option><option value='Le Haut-Saint-Laurent' >Le Haut-Saint-Laurent<\/option><option value='Le Rocher-Perc\u00e9' >Le Rocher-Perc\u00e9<\/option><option value='Le Val-Saint-Fran\u00e7ois' >Le Val-Saint-Fran\u00e7ois<\/option><option value='Lebel-sur-Qu\u00e9villon' >Lebel-sur-Qu\u00e9villon<\/option><option value='Leclercville' >Leclercville<\/option><option value='Lefebvre' >Lefebvre<\/option><option value='Lejeune' >Lejeune<\/option><option value='Lemieux' >Lemieux<\/option><option value='L\u00e9ry' >L\u00e9ry<\/option><option value='Les Appalaches' >Les Appalaches<\/option><option value='Les Basques' >Les Basques<\/option><option value='Les Bergeronnes' >Les Bergeronnes<\/option><option value='Les C\u00e8dres' >Les C\u00e8dres<\/option><option value='Les Chenaux' >Les Chenaux<\/option><option value='Les Collines-de-l&#039;Outaouais' >Les Collines-de-l&#039;Outaouais<\/option><option value='Les Coteaux' >Les Coteaux<\/option><option value='Les \u00c9boulements' >Les \u00c9boulements<\/option><option value='Les Escoumins' >Les Escoumins<\/option><option value='Les Etchemins' >Les Etchemins<\/option><option value='Les Hauteurs' >Les Hauteurs<\/option><option value='Les \u00celes-de-la-Madeleine' >Les \u00celes-de-la-Madeleine<\/option><option value='Les Jardins-de-Napierville' >Les Jardins-de-Napierville<\/option><option value='Les Laurentides' >Les Laurentides<\/option><option value='Les Maskoutains' >Les Maskoutains<\/option><option value='Les M\u00e9chins' >Les M\u00e9chins<\/option><option value='Les Moulins' >Les Moulins<\/option><option value='Les Pays-d&#039;en-Haut' >Les Pays-d&#039;en-Haut<\/option><option value='Les Sources' >Les Sources<\/option><option value='L\u00e9vis' >L\u00e9vis<\/option><option value='Lingwick' >Lingwick<\/option><option value='Litchfield' >Litchfield<\/option><option value='Lochaber' >Lochaber<\/option><option value='Lochaber-Partie-Ouest' >Lochaber-Partie-Ouest<\/option><option value='Longue-Pointe-de-Mingan' >Longue-Pointe-de-Mingan<\/option><option value='Longue-Rive' >Longue-Rive<\/option><option value='Longueuil' >Longueuil<\/option><option value='Lorraine' >Lorraine<\/option><option value='Lorrainville' >Lorrainville<\/option><option value='Lotbini\u00e8re' >Lotbini\u00e8re<\/option><option value='Louiseville' >Louiseville<\/option><option value='Low' >Low<\/option><option value='Lyster' >Lyster<\/option><option value='Macamic' >Macamic<\/option><option value='Maddington Falls' >Maddington Falls<\/option><option value='Magog' >Magog<\/option><option value='Malartic' >Malartic<\/option><option value='Mandeville' >Mandeville<\/option><option value='Manicouagan' >Manicouagan<\/option><option value='Maniwaki' >Maniwaki<\/option><option value='Manseau' >Manseau<\/option><option value='Mansfield-et-Pontefract' >Mansfield-et-Pontefract<\/option><option value='Marguerite-D&#039;Youville' >Marguerite-D&#039;Youville<\/option><option value='Maria' >Maria<\/option><option value='Maria-Chapdelaine' >Maria-Chapdelaine<\/option><option value='Maricourt' >Maricourt<\/option><option value='Marieville' >Marieville<\/option><option value='Marsoui' >Marsoui<\/option><option value='Marston' >Marston<\/option><option value='Martinville' >Martinville<\/option><option value='Mascouche' >Mascouche<\/option><option value='Maskinong\u00e9' >Maskinong\u00e9<\/option><option value='Maskinong\u00e9' >Maskinong\u00e9<\/option><option value='Massueville' >Massueville<\/option><option value='Matagami' >Matagami<\/option><option value='Matane' >Matane<\/option><option value='Matap\u00e9dia' >Matap\u00e9dia<\/option><option value='Matawinie' >Matawinie<\/option><option value='Mayo' >Mayo<\/option><option value='McMasterville' >McMasterville<\/option><option value='M\u00e9kinac' >M\u00e9kinac<\/option><option value='Melbourne' >Melbourne<\/option><option value='Memphr\u00e9magog' >Memphr\u00e9magog<\/option><option value='Mercier' >Mercier<\/option><option value='Messines' >Messines<\/option><option value='M\u00e9tabetchouan--Lac-\u00e0-la-Croix' >M\u00e9tabetchouan&#8211;Lac-\u00e0-la-Croix<\/option><option value='M\u00e9tis-sur-Mer' >M\u00e9tis-sur-Mer<\/option><option value='Milan' >Milan<\/option><option value='Mille-Isles' >Mille-Isles<\/option><option value='Minganie' >Minganie<\/option><option value='Mirabel' >Mirabel<\/option><option value='Mistissini' >Mistissini<\/option><option value='Moffet' >Moffet<\/option><option value='Mont-Carmel' >Mont-Carmel<\/option><option value='Mont-Joli' >Mont-Joli<\/option><option value='Mont-Laurier' >Mont-Laurier<\/option><option value='Mont-Royal' >Mont-Royal<\/option><option value='Mont-Saint-Gr\u00e9goire' >Mont-Saint-Gr\u00e9goire<\/option><option value='Mont-Saint-Hilaire' >Mont-Saint-Hilaire<\/option><option value='Mont-Saint-Michel' >Mont-Saint-Michel<\/option><option value='Mont-Saint-Pierre' >Mont-Saint-Pierre<\/option><option value='Mont-Tremblant' >Mont-Tremblant<\/option><option value='Montcalm' >Montcalm<\/option><option value='Montcerf-Lytton' >Montcerf-Lytton<\/option><option value='Montebello' >Montebello<\/option><option value='Montmagny' >Montmagny<\/option><option value='Montpellier' >Montpellier<\/option><option value='Montr\u00e9al' >Montr\u00e9al<\/option><option value='Montr\u00e9al-Est' >Montr\u00e9al-Est<\/option><option value='Montr\u00e9al-Ouest' >Montr\u00e9al-Ouest<\/option><option value='Morin-Heights' >Morin-Heights<\/option><option value='Mulgrave-et-Derry' >Mulgrave-et-Derry<\/option><option value='Murdochville' >Murdochville<\/option><option value='Namur' >Namur<\/option><option value='Nantes' >Nantes<\/option><option value='Napierville' >Napierville<\/option><option value='Natashquan' >Natashquan<\/option><option value='N\u00e9d\u00e9lec' >N\u00e9d\u00e9lec<\/option><option value='Nemaska' >Nemaska<\/option><option value='Neuville' >Neuville<\/option><option value='New Carlisle' >New Carlisle<\/option><option value='New Richmond' >New Richmond<\/option><option value='Newport' >Newport<\/option><option value='Nicolet' >Nicolet<\/option><option value='Nicolet-Yamaska' >Nicolet-Yamaska<\/option><option value='Nominingue' >Nominingue<\/option><option value='Normandin' >Normandin<\/option><option value='Norm\u00e9tal' >Norm\u00e9tal<\/option><option value='North Hatley' >North Hatley<\/option><option value='Notre-Dame-Auxiliatrice-de-Buckland' >Notre-Dame-Auxiliatrice-de-Buckland<\/option><option value='Notre-Dame-de-Bonsecours' >Notre-Dame-de-Bonsecours<\/option><option value='Notre-Dame-de-Ham' >Notre-Dame-de-Ham<\/option><option value='Notre-Dame-de-Lorette' >Notre-Dame-de-Lorette<\/option><option value='Notre-Dame-de-Lourdes' >Notre-Dame-de-Lourdes<\/option><option value='Notre-Dame-de-Montauban' >Notre-Dame-de-Montauban<\/option><option value='Notre-Dame-de-Pontmain' >Notre-Dame-de-Pontmain<\/option><option value='Notre-Dame-de-Stanbridge' >Notre-Dame-de-Stanbridge<\/option><option value='Notre-Dame-de-l&#039;\u00cele-Perrot' >Notre-Dame-de-l&#039;\u00cele-Perrot<\/option><option value='Notre-Dame-de-la-Merci' >Notre-Dame-de-la-Merci<\/option><option value='Notre-Dame-de-la-Paix' >Notre-Dame-de-la-Paix<\/option><option value='Notre-Dame-de-la-Salette' >Notre-Dame-de-la-Salette<\/option><option value='Notre-Dame-des-Anges' >Notre-Dame-des-Anges<\/option><option value='Notre-Dame-des-Bois' >Notre-Dame-des-Bois<\/option><option value='Notre-Dame-des-Monts' >Notre-Dame-des-Monts<\/option><option value='Notre-Dame-des-Neiges' >Notre-Dame-des-Neiges<\/option><option value='Notre-Dame-des-Pins' >Notre-Dame-des-Pins<\/option><option value='Notre-Dame-des-Prairies' >Notre-Dame-des-Prairies<\/option><option value='Notre-Dame-des-Sept-Douleurs' >Notre-Dame-des-Sept-Douleurs<\/option><option value='Notre-Dame-du-Bon-Conseil' >Notre-Dame-du-Bon-Conseil<\/option><option value='Notre-Dame-du-Bon-Conseil' >Notre-Dame-du-Bon-Conseil<\/option><option value='Notre-Dame-du-Laus' >Notre-Dame-du-Laus<\/option><option value='Notre-Dame-du-Mont-Carmel' >Notre-Dame-du-Mont-Carmel<\/option><option value='Notre-Dame-du-Nord' >Notre-Dame-du-Nord<\/option><option value='Notre-Dame-du-Portage' >Notre-Dame-du-Portage<\/option><option value='Notre-Dame-du-Rosaire' >Notre-Dame-du-Rosaire<\/option><option value='Notre-Dame-du-Sacr\u00e9-C\u0153ur-d&#039;Issoudun' >Notre-Dame-du-Sacr\u00e9-C\u0153ur-d&#039;Issoudun<\/option><option value='Nouvelle' >Nouvelle<\/option><option value='Noyan' >Noyan<\/option><option value='Ogden' >Ogden<\/option><option value='Oka' >Oka<\/option><option value='Orford' >Orford<\/option><option value='Ormstown' >Ormstown<\/option><option value='Otter Lake' >Otter Lake<\/option><option value='Otterburn Park' >Otterburn Park<\/option><option value='Packington' >Packington<\/option><option value='Padoue' >Padoue<\/option><option value='Palmarolle' >Palmarolle<\/option><option value='Papineau' >Papineau<\/option><option value='Papineauville' >Papineauville<\/option><option value='Parisville' >Parisville<\/option><option value='Pasp\u00e9biac' >Pasp\u00e9biac<\/option><option value='Perc\u00e9' >Perc\u00e9<\/option><option value='P\u00e9ribonka' >P\u00e9ribonka<\/option><option value='Petit-Saguenay' >Petit-Saguenay<\/option><option value='Petite-Rivi\u00e8re-Saint-Fran\u00e7ois' >Petite-Rivi\u00e8re-Saint-Fran\u00e7ois<\/option><option value='Petite-Vall\u00e9e' >Petite-Vall\u00e9e<\/option><option value='Piedmont' >Piedmont<\/option><option value='Pierre-De Saurel' >Pierre-De Saurel<\/option><option value='Pierreville' >Pierreville<\/option><option value='Pike-River' >Pike-River<\/option><option value='Pincourt' >Pincourt<\/option><option value='Piopolis' >Piopolis<\/option><option value='Plaisance' >Plaisance<\/option><option value='Plessisville' >Plessisville<\/option><option value='Poh\u00e9n\u00e9gamook' >Poh\u00e9n\u00e9gamook<\/option><option value='Pointe-Calumet' >Pointe-Calumet<\/option><option value='Pointe-Claire' >Pointe-Claire<\/option><option value='Pointe-Fortune' >Pointe-Fortune<\/option><option value='Pointe-Lebel' >Pointe-Lebel<\/option><option value='Pointe-\u00e0-la-Croix' >Pointe-\u00e0-la-Croix<\/option><option value='Pointe-aux-Outardes' >Pointe-aux-Outardes<\/option><option value='Pointe-des-Cascades' >Pointe-des-Cascades<\/option><option value='Pont-Rouge' >Pont-Rouge<\/option><option value='Pontiac' >Pontiac<\/option><option value='Port-Cartier' >Port-Cartier<\/option><option value='Port-Daniel--Gascons' >Port-Daniel&#8211;Gascons<\/option><option value='Portage-du-Fort' >Portage-du-Fort<\/option><option value='Portage-du-Fort' >Portage-du-Fort<\/option><option value='Portneuf-sur-Mer' >Portneuf-sur-Mer<\/option><option value='Potton' >Potton<\/option><option value='Poularies' >Poularies<\/option><option value='Preissac' >Preissac<\/option><option value='Pr\u00e9vost' >Pr\u00e9vost<\/option><option value='Price' >Price<\/option><option value='Princeville' >Princeville<\/option><option value='Puvirnituq' >Puvirnituq<\/option><option value='Quaqtaq' >Quaqtaq<\/option><option value='Quebec City' >Quebec City<\/option><option value='Racine' >Racine<\/option><option value='Ragueneau' >Ragueneau<\/option><option value='Rapide-Danseur' >Rapide-Danseur<\/option><option value='Rapides-des-Joachims' >Rapides-des-Joachims<\/option><option value='Rawdon' >Rawdon<\/option><option value='R\u00e9migny' >R\u00e9migny<\/option><option value='Repentigny' >Repentigny<\/option><option value='Richelieu' >Richelieu<\/option><option value='Richmond' >Richmond<\/option><option value='Rigaud' >Rigaud<\/option><option value='Rimouski' >Rimouski<\/option><option value='Rimouski-Neigette' >Rimouski-Neigette<\/option><option value='Ripon' >Ripon<\/option><option value='Ristigouche-Partie-Sud-Est' >Ristigouche-Partie-Sud-Est<\/option><option value='Rivi\u00e8re-Beaudette' >Rivi\u00e8re-Beaudette<\/option><option value='Rivi\u00e8re-Bleue' >Rivi\u00e8re-Bleue<\/option><option value='Rivi\u00e8re-\u00c9ternit\u00e9' >Rivi\u00e8re-\u00c9ternit\u00e9<\/option><option value='Rivi\u00e8re-H\u00e9va' >Rivi\u00e8re-H\u00e9va<\/option><option value='Rivi\u00e8re-Ouelle' >Rivi\u00e8re-Ouelle<\/option><option value='Rivi\u00e8re-Rouge' >Rivi\u00e8re-Rouge<\/option><option value='Rivi\u00e8re-Saint-Jean' >Rivi\u00e8re-Saint-Jean<\/option><option value='Rivi\u00e8re-\u00e0-Claude' >Rivi\u00e8re-\u00e0-Claude<\/option><option value='Rivi\u00e8re-\u00e0-Pierre' >Rivi\u00e8re-\u00e0-Pierre<\/option><option value='Rivi\u00e8re-au-Tonnerre' >Rivi\u00e8re-au-Tonnerre<\/option><option value='Rivi\u00e8re-du-Loup' >Rivi\u00e8re-du-Loup<\/option><option value='Rivi\u00e8re-du-Loup' >Rivi\u00e8re-du-Loup<\/option><option value='Robert-Cliche' >Robert-Cliche<\/option><option value='Roberval' >Roberval<\/option><option value='Rochebaucourt' >Rochebaucourt<\/option><option value='Roquemaure' >Roquemaure<\/option><option value='Rosem\u00e8re' >Rosem\u00e8re<\/option><option value='Rougemont' >Rougemont<\/option><option value='Roussillon' >Roussillon<\/option><option value='Rouville' >Rouville<\/option><option value='Rouyn-Noranda' >Rouyn-Noranda<\/option><option value='Roxton' >Roxton<\/option><option value='Roxton Falls' >Roxton Falls<\/option><option value='Roxton Pond' >Roxton Pond<\/option><option value='Sacr\u00e9-C\u0153ur' >Sacr\u00e9-C\u0153ur<\/option><option value='Sacr\u00e9-C\u0153ur-de-J\u00e9sus' >Sacr\u00e9-C\u0153ur-de-J\u00e9sus<\/option><option value='Saguenay' >Saguenay<\/option><option value='Saint-Adalbert' >Saint-Adalbert<\/option><option value='Saint-Adelme' >Saint-Adelme<\/option><option value='Saint-Adelphe' >Saint-Adelphe<\/option><option value='Saint-Adolphe-d&#039;Howard' >Saint-Adolphe-d&#039;Howard<\/option><option value='Saint-Adrien' >Saint-Adrien<\/option><option value='Saint-Adrien-d&#039;Irlande' >Saint-Adrien-d&#039;Irlande<\/option><option value='Saint-Agapit' >Saint-Agapit<\/option><option value='Saint-Aim\u00e9' >Saint-Aim\u00e9<\/option><option value='Saint-Aim\u00e9-des-Lacs' >Saint-Aim\u00e9-des-Lacs<\/option><option value='Saint-Aim\u00e9-du-Lac-des-\u00celes' >Saint-Aim\u00e9-du-Lac-des-\u00celes<\/option><option value='Saint-Alban' >Saint-Alban<\/option><option value='Saint-Albert' >Saint-Albert<\/option><option value='Saint-Alexandre' >Saint-Alexandre<\/option><option value='Saint-Alexandre-de-Kamouraska' >Saint-Alexandre-de-Kamouraska<\/option><option value='Saint-Alexandre-des-Lacs' >Saint-Alexandre-des-Lacs<\/option><option value='Saint-Alexis' >Saint-Alexis<\/option><option value='Saint-Alexis-de-Matap\u00e9dia' >Saint-Alexis-de-Matap\u00e9dia<\/option><option value='Saint-Alexis-des-Monts' >Saint-Alexis-des-Monts<\/option><option value='Saint-Alfred' >Saint-Alfred<\/option><option value='Saint-Alphonse' >Saint-Alphonse<\/option><option value='Saint-Alphonse-Rodriguez' >Saint-Alphonse-Rodriguez<\/option><option value='Saint-Alphonse-de-Granby' >Saint-Alphonse-de-Granby<\/option><option value='Saint-Amable' >Saint-Amable<\/option><option value='Saint-Ambroise' >Saint-Ambroise<\/option><option value='Saint-Ambroise-de-Kildare' >Saint-Ambroise-de-Kildare<\/option><option value='Saint-Anaclet-de-Lessard' >Saint-Anaclet-de-Lessard<\/option><option value='Saint-Andr\u00e9' >Saint-Andr\u00e9<\/option><option value='Saint-Andr\u00e9-Avellin' >Saint-Andr\u00e9-Avellin<\/option><option value='Saint-Andr\u00e9-d&#039;Argenteuil' >Saint-Andr\u00e9-d&#039;Argenteuil<\/option><option value='Saint-Andr\u00e9-de-Restigouche' >Saint-Andr\u00e9-de-Restigouche<\/option><option value='Saint-Andr\u00e9-du-Lac-Saint-Jean' >Saint-Andr\u00e9-du-Lac-Saint-Jean<\/option><option value='Saint-Anicet' >Saint-Anicet<\/option><option value='Saint-Anselme' >Saint-Anselme<\/option><option value='Saint-Antoine-de-Tilly' >Saint-Antoine-de-Tilly<\/option><option value='Saint-Antoine-de-l&#039;Isle-aux-Grues' >Saint-Antoine-de-l&#039;Isle-aux-Grues<\/option><option value='Saint-Antoine-sur-Richelieu' >Saint-Antoine-sur-Richelieu<\/option><option value='Saint-Antonin' >Saint-Antonin<\/option><option value='Saint-Apollinaire' >Saint-Apollinaire<\/option><option value='Saint-Armand' >Saint-Armand<\/option><option value='Saint-Ars\u00e8ne' >Saint-Ars\u00e8ne<\/option><option value='Saint-Athanase' >Saint-Athanase<\/option><option value='Saint-Aubert' >Saint-Aubert<\/option><option value='Saint-Augustin' >Saint-Augustin<\/option><option value='Saint-Augustin' >Saint-Augustin<\/option><option value='Saint-Augustin-de-Desmaures' >Saint-Augustin-de-Desmaures<\/option><option value='Saint-Augustin-de-Woburn' >Saint-Augustin-de-Woburn<\/option><option value='Saint-Barnab\u00e9' >Saint-Barnab\u00e9<\/option><option value='Saint-Barnab\u00e9-Sud' >Saint-Barnab\u00e9-Sud<\/option><option value='Saint-Barth\u00e9lemy' >Saint-Barth\u00e9lemy<\/option><option value='Saint-Basile' >Saint-Basile<\/option><option value='Saint-Basile-le-Grand' >Saint-Basile-le-Grand<\/option><option value='Saint-Benjamin' >Saint-Benjamin<\/option><option value='Saint-Beno\u00eet-Labre' >Saint-Beno\u00eet-Labre<\/option><option value='Saint-Beno\u00eet-du-Lac' >Saint-Beno\u00eet-du-Lac<\/option><option value='Saint-Bernard' >Saint-Bernard<\/option><option value='Saint-Bernard-de-Lacolle' >Saint-Bernard-de-Lacolle<\/option><option value='Saint-Bernard-de-Michaudville' >Saint-Bernard-de-Michaudville<\/option><option value='Saint-Blaise-sur-Richelieu' >Saint-Blaise-sur-Richelieu<\/option><option value='Saint-Bonaventure' >Saint-Bonaventure<\/option><option value='Saint-Boniface' >Saint-Boniface<\/option><option value='Saint-Bruno' >Saint-Bruno<\/option><option value='Saint-Bruno-de-Guigues' >Saint-Bruno-de-Guigues<\/option><option value='Saint-Bruno-de-Kamouraska' >Saint-Bruno-de-Kamouraska<\/option><option value='Saint-Bruno-de-Montarville' >Saint-Bruno-de-Montarville<\/option><option value='Saint-Calixte' >Saint-Calixte<\/option><option value='Saint-Camille' >Saint-Camille<\/option><option value='Saint-Camille-de-Lellis' >Saint-Camille-de-Lellis<\/option><option value='Saint-Casimir' >Saint-Casimir<\/option><option value='Saint-C\u00e9lestin' >Saint-C\u00e9lestin<\/option><option value='Saint-C\u00e9saire' >Saint-C\u00e9saire<\/option><option value='Saint-Charles-Borrom\u00e9e' >Saint-Charles-Borrom\u00e9e<\/option><option value='Saint-Charles-Garnier' >Saint-Charles-Garnier<\/option><option value='Saint-Charles-de-Bellechasse' >Saint-Charles-de-Bellechasse<\/option><option value='Saint-Charles-de-Bourget' >Saint-Charles-de-Bourget<\/option><option value='Saint-Charles-sur-Richelieu' >Saint-Charles-sur-Richelieu<\/option><option value='Saint-Christophe-d&#039;Arthabaska' >Saint-Christophe-d&#039;Arthabaska<\/option><option value='Saint-Chrysostome' >Saint-Chrysostome<\/option><option value='Saint-Claude' >Saint-Claude<\/option><option value='Saint-Cl\u00e9ment' >Saint-Cl\u00e9ment<\/option><option value='Saint-Cl\u00e9ophas' >Saint-Cl\u00e9ophas<\/option><option value='Saint-Cl\u00e9ophas-de-Brandon' >Saint-Cl\u00e9ophas-de-Brandon<\/option><option value='Saint-Clet' >Saint-Clet<\/option><option value='Saint-Colomban' >Saint-Colomban<\/option><option value='Saint-C\u00f4me' >Saint-C\u00f4me<\/option><option value='Saint-C\u00f4me-Lini\u00e8re' >Saint-C\u00f4me-Lini\u00e8re<\/option><option value='Saint-Constant' >Saint-Constant<\/option><option value='Saint-Cuthbert' >Saint-Cuthbert<\/option><option value='Saint-Cyprien' >Saint-Cyprien<\/option><option value='Saint-Cyprien' >Saint-Cyprien<\/option><option value='Saint-Cyprien-de-Napierville' >Saint-Cyprien-de-Napierville<\/option><option value='Saint-Cyrille-de-Lessard' >Saint-Cyrille-de-Lessard<\/option><option value='Saint-Cyrille-de-Wendover' >Saint-Cyrille-de-Wendover<\/option><option value='Saint-Damase' >Saint-Damase<\/option><option value='Saint-Damase-de-L&#039;Islet' >Saint-Damase-de-L&#039;Islet<\/option><option value='Saint-Damien' >Saint-Damien<\/option><option value='Saint-Damien-de-Buckland' >Saint-Damien-de-Buckland<\/option><option value='Saint-David' >Saint-David<\/option><option value='Saint-David-de-Falardeau' >Saint-David-de-Falardeau<\/option><option value='Saint-Denis-de-Brompton' >Saint-Denis-de-Brompton<\/option><option value='Saint-Denis-de-la-Bouteillerie' >Saint-Denis-de-la-Bouteillerie<\/option><option value='Saint-Denis-sur-Richelieu' >Saint-Denis-sur-Richelieu<\/option><option value='Saint-Denis-sur-Richelieu' >Saint-Denis-sur-Richelieu<\/option><option value='Saint-Dominique' >Saint-Dominique<\/option><option value='Saint-Dominique-du-Rosaire' >Saint-Dominique-du-Rosaire<\/option><option value='Saint-Donat' >Saint-Donat<\/option><option value='Saint-Edmond-de-Grantham' >Saint-Edmond-de-Grantham<\/option><option value='Saint-Edmond-les-Plaines' >Saint-Edmond-les-Plaines<\/option><option value='Saint-\u00c9douard' >Saint-\u00c9douard<\/option><option value='Saint-\u00c9douard-de-Fabre' >Saint-\u00c9douard-de-Fabre<\/option><option value='Saint-\u00c9douard-de-Lotbini\u00e8re' >Saint-\u00c9douard-de-Lotbini\u00e8re<\/option><option value='Saint-\u00c9douard-de-Maskinong\u00e9' >Saint-\u00c9douard-de-Maskinong\u00e9<\/option><option value='Saint-\u00c9lie-de-Caxton' >Saint-\u00c9lie-de-Caxton<\/option><option value='Saint-\u00c9loi' >Saint-\u00c9loi<\/option><option value='Saint-Elph\u00e8ge' >Saint-Elph\u00e8ge<\/option><option value='Saint-Elz\u00e9ar' >Saint-Elz\u00e9ar<\/option><option value='Saint-Elz\u00e9ar-de-T\u00e9miscouata' >Saint-Elz\u00e9ar-de-T\u00e9miscouata<\/option><option value='Saint-\u00c9mile-de-Suffolk' >Saint-\u00c9mile-de-Suffolk<\/option><option value='Saint-\u00c9phrem-de-Beauce' >Saint-\u00c9phrem-de-Beauce<\/option><option value='Saint-\u00c9piphane' >Saint-\u00c9piphane<\/option><option value='Saint-Esprit' >Saint-Esprit<\/option><option value='Saint-\u00c9tienne-de-Beauharnois' >Saint-\u00c9tienne-de-Beauharnois<\/option><option value='Saint-\u00c9tienne-de-Bolton' >Saint-\u00c9tienne-de-Bolton<\/option><option value='Saint-\u00c9tienne-des-Gr\u00e8s' >Saint-\u00c9tienne-des-Gr\u00e8s<\/option><option value='Saint-Eug\u00e8ne' >Saint-Eug\u00e8ne<\/option><option value='Saint-Eug\u00e8ne-d&#039;Argentenay' >Saint-Eug\u00e8ne-d&#039;Argentenay<\/option><option value='Saint-Eug\u00e8ne-de-Guigues' >Saint-Eug\u00e8ne-de-Guigues<\/option><option value='Saint-Eug\u00e8ne-de-Ladri\u00e8re' >Saint-Eug\u00e8ne-de-Ladri\u00e8re<\/option><option value='Saint-Eus\u00e8be' >Saint-Eus\u00e8be<\/option><option value='Saint-Eustache' >Saint-Eustache<\/option><option value='Saint-\u00c9variste-de-Forsyth' >Saint-\u00c9variste-de-Forsyth<\/option><option value='Saint-Fabien' >Saint-Fabien<\/option><option value='Saint-Fabien-de-Panet' >Saint-Fabien-de-Panet<\/option><option value='Saint-Faustin--Lac-Carr\u00e9' >Saint-Faustin&#8211;Lac-Carr\u00e9<\/option><option value='Saint-F\u00e9licien' >Saint-F\u00e9licien<\/option><option value='Saint-F\u00e9lix-d&#039;Otis' >Saint-F\u00e9lix-d&#039;Otis<\/option><option value='Saint-F\u00e9lix-de-Dalquier' >Saint-F\u00e9lix-de-Dalquier<\/option><option value='Saint-F\u00e9lix-de-Kingsey' >Saint-F\u00e9lix-de-Kingsey<\/option><option value='Saint-F\u00e9lix-de-Valois' >Saint-F\u00e9lix-de-Valois<\/option><option value='Saint-Ferdinand' >Saint-Ferdinand<\/option><option value='Saint-Ferr\u00e9ol-les-Neiges' >Saint-Ferr\u00e9ol-les-Neiges<\/option><option value='Saint-Flavien' >Saint-Flavien<\/option><option value='Saint-Fortunat' >Saint-Fortunat<\/option><option value='Saint-Fran\u00e7ois-Xavier-de-Brompton' >Saint-Fran\u00e7ois-Xavier-de-Brompton<\/option><option value='Saint-Fran\u00e7ois-Xavier-de-Viger' >Saint-Fran\u00e7ois-Xavier-de-Viger<\/option><option value='Saint-Fran\u00e7ois-d&#039;Assise' >Saint-Fran\u00e7ois-d&#039;Assise<\/option><option value='Saint-Fran\u00e7ois-de-Sales' >Saint-Fran\u00e7ois-de-Sales<\/option><option value='Saint-Fran\u00e7ois-de-l&#039;\u00cele-d&#039;Orl\u00e9ans' >Saint-Fran\u00e7ois-de-l&#039;\u00cele-d&#039;Orl\u00e9ans<\/option><option value='Saint-Fran\u00e7ois-de-la-Rivi\u00e8re-du-Sud' >Saint-Fran\u00e7ois-de-la-Rivi\u00e8re-du-Sud<\/option><option value='Saint-Fran\u00e7ois-du-Lac' >Saint-Fran\u00e7ois-du-Lac<\/option><option value='Saint-Fr\u00e9d\u00e9ric' >Saint-Fr\u00e9d\u00e9ric<\/option><option value='Saint-Fulgence' >Saint-Fulgence<\/option><option value='Saint-Gabriel' >Saint-Gabriel<\/option><option value='Saint-Gabriel-Lalemant' >Saint-Gabriel-Lalemant<\/option><option value='Saint-Gabriel-de-Brandon' >Saint-Gabriel-de-Brandon<\/option><option value='Saint-Gabriel-de-Rimouski' >Saint-Gabriel-de-Rimouski<\/option><option value='Saint-Gabriel-de-Valcartier' >Saint-Gabriel-de-Valcartier<\/option><option value='Saint-G\u00e9d\u00e9on' >Saint-G\u00e9d\u00e9on<\/option><option value='Saint-G\u00e9d\u00e9on-de-Beauce' >Saint-G\u00e9d\u00e9on-de-Beauce<\/option><option value='Saint-Georges' >Saint-Georges<\/option><option value='Saint-Georges-de-Clarenceville' >Saint-Georges-de-Clarenceville<\/option><option value='Saint-Georges-de-Windsor' >Saint-Georges-de-Windsor<\/option><option value='Saint-G\u00e9rard-Majella' >Saint-G\u00e9rard-Majella<\/option><option value='Saint-Germain' >Saint-Germain<\/option><option value='Saint-Germain-de-Grantham' >Saint-Germain-de-Grantham<\/option><option value='Saint-Gervais' >Saint-Gervais<\/option><option value='Saint-Gilbert' >Saint-Gilbert<\/option><option value='Saint-Gilles' >Saint-Gilles<\/option><option value='Saint-Godefroi' >Saint-Godefroi<\/option><option value='Saint-Guillaume' >Saint-Guillaume<\/option><option value='Saint-Guy' >Saint-Guy<\/option><option value='Saint-Henri' >Saint-Henri<\/option><option value='Saint-Henri-de-Taillon' >Saint-Henri-de-Taillon<\/option><option value='Saint-Herm\u00e9n\u00e9gilde' >Saint-Herm\u00e9n\u00e9gilde<\/option><option value='Saint-Hilaire-de-Dorset' >Saint-Hilaire-de-Dorset<\/option><option value='Saint-Hilarion' >Saint-Hilarion<\/option><option value='Saint-Hippolyte' >Saint-Hippolyte<\/option><option value='Saint-Honor\u00e9' >Saint-Honor\u00e9<\/option><option value='Saint-Honor\u00e9-de-Shenley' >Saint-Honor\u00e9-de-Shenley<\/option><option value='Saint-Honor\u00e9-de-T\u00e9miscouata' >Saint-Honor\u00e9-de-T\u00e9miscouata<\/option><option value='Saint-Hubert-de-Rivi\u00e8re-du-Loup' >Saint-Hubert-de-Rivi\u00e8re-du-Loup<\/option><option value='Saint-Hugues' >Saint-Hugues<\/option><option value='Saint-Hyacinthe' >Saint-Hyacinthe<\/option><option value='Saint-Ignace-de-Loyola' >Saint-Ignace-de-Loyola<\/option><option value='Saint-Ignace-de-Stanbridge' >Saint-Ignace-de-Stanbridge<\/option><option value='Saint-Ir\u00e9n\u00e9e' >Saint-Ir\u00e9n\u00e9e<\/option><option value='Saint-Isidore' >Saint-Isidore<\/option><option value='Saint-Isidore-de-Clifton' >Saint-Isidore-de-Clifton<\/option><option value='Saint-Jacques' >Saint-Jacques<\/option><option value='Saint-Jacques-de-Leeds' >Saint-Jacques-de-Leeds<\/option><option value='Saint-Jacques-le-Majeur-de-Wolfestown' >Saint-Jacques-le-Majeur-de-Wolfestown<\/option><option value='Saint-Jacques-le-Mineur' >Saint-Jacques-le-Mineur<\/option><option value='Saint-Janvier-de-Joly' >Saint-Janvier-de-Joly<\/option><option value='Saint-Jean-Baptiste' >Saint-Jean-Baptiste<\/option><option value='Saint-Jean-Port-Joli' >Saint-Jean-Port-Joli<\/option><option value='Saint-Jean-de-Br\u00e9beuf' >Saint-Jean-de-Br\u00e9beuf<\/option><option value='Saint-Jean-de-Cherbourg' >Saint-Jean-de-Cherbourg<\/option><option value='Saint-Jean-de-Dieu' >Saint-Jean-de-Dieu<\/option><option value='Saint-Jean-de-Matha' >Saint-Jean-de-Matha<\/option><option value='Saint-Jean-de-l&#039;\u00cele-d&#039;Orl\u00e9ans' >Saint-Jean-de-l&#039;\u00cele-d&#039;Orl\u00e9ans<\/option><option value='Saint-Jean-de-la-Lande' >Saint-Jean-de-la-Lande<\/option><option value='Saint-Jean-sur-Richelieu' >Saint-Jean-sur-Richelieu<\/option><option value='Saint-J\u00e9r\u00f4me' >Saint-J\u00e9r\u00f4me<\/option><option value='Saint-Joachim' >Saint-Joachim<\/option><option value='Saint-Joachim-de-Shefford' >Saint-Joachim-de-Shefford<\/option><option value='Saint-Joseph-de-Beauce' >Saint-Joseph-de-Beauce<\/option><option value='Saint-Joseph-de-Coleraine' >Saint-Joseph-de-Coleraine<\/option><option value='Saint-Joseph-de-Kamouraska' >Saint-Joseph-de-Kamouraska<\/option><option value='Saint-Joseph-de-Lepage' >Saint-Joseph-de-Lepage<\/option><option value='Saint-Joseph-de-Sorel' >Saint-Joseph-de-Sorel<\/option><option value='Saint-Joseph-des-\u00c9rables' >Saint-Joseph-des-\u00c9rables<\/option><option value='Saint-Joseph-du-Lac' >Saint-Joseph-du-Lac<\/option><option value='Saint-Jude' >Saint-Jude<\/option><option value='Saint-Jules' >Saint-Jules<\/option><option value='Saint-Julien' >Saint-Julien<\/option><option value='Saint-Just-de-Breteni\u00e8res' >Saint-Just-de-Breteni\u00e8res<\/option><option value='Saint-Juste-du-Lac' >Saint-Juste-du-Lac<\/option><option value='Saint-Justin' >Saint-Justin<\/option><option value='Saint-Lambert' >Saint-Lambert<\/option><option value='Saint-Lambert' >Saint-Lambert<\/option><option value='Saint-Lambert-de-Lauzon' >Saint-Lambert-de-Lauzon<\/option><option value='Saint-Laurent-de-l&#039;\u00cele-d&#039;Orl\u00e9ans' >Saint-Laurent-de-l&#039;\u00cele-d&#039;Orl\u00e9ans<\/option><option value='Saint-Lazare' >Saint-Lazare<\/option><option value='Saint-Lazare-de-Bellechasse' >Saint-Lazare-de-Bellechasse<\/option><option value='Saint-L\u00e9andre' >Saint-L\u00e9andre<\/option><option value='Saint-L\u00e9on-de-Standon' >Saint-L\u00e9on-de-Standon<\/option><option value='Saint-L\u00e9on-le-Grand' >Saint-L\u00e9on-le-Grand<\/option><option value='Saint-L\u00e9on-le-Grand' >Saint-L\u00e9on-le-Grand<\/option><option value='Saint-L\u00e9onard-d&#039;Aston' >Saint-L\u00e9onard-d&#039;Aston<\/option><option value='Saint-L\u00e9onard-de-Portneuf' >Saint-L\u00e9onard-de-Portneuf<\/option><option value='Saint-Liboire' >Saint-Liboire<\/option><option value='Saint-Liguori' >Saint-Liguori<\/option><option value='Saint-Lin--Laurentides' >Saint-Lin&#8211;Laurentides<\/option><option value='Saint-Louis' >Saint-Louis<\/option><option value='Saint-Louis-de-Blandford' >Saint-Louis-de-Blandford<\/option><option value='Saint-Louis-de-Gonzague' >Saint-Louis-de-Gonzague<\/option><option value='Saint-Louis-de-Gonzague' >Saint-Louis-de-Gonzague<\/option><option value='Saint-Louis-de-Gonzague-du-Cap-Tourmente' >Saint-Louis-de-Gonzague-du-Cap-Tourmente<\/option><option value='Saint-Louis-du-Ha! Ha!' >Saint-Louis-du-Ha! Ha!<\/option><option value='Saint-Luc-de-Bellechasse' >Saint-Luc-de-Bellechasse<\/option><option value='Saint-Luc-de-Vincennes' >Saint-Luc-de-Vincennes<\/option><option value='Saint-Lucien' >Saint-Lucien<\/option><option value='Saint-Ludger' >Saint-Ludger<\/option><option value='Saint-Ludger-de-Milot' >Saint-Ludger-de-Milot<\/option><option value='Saint-Magloire' >Saint-Magloire<\/option><option value='Saint-Majorique-de-Grantham' >Saint-Majorique-de-Grantham<\/option><option value='Saint-Malachie' >Saint-Malachie<\/option><option value='Saint-Malo' >Saint-Malo<\/option><option value='Saint-Marc-de-Figuery' >Saint-Marc-de-Figuery<\/option><option value='Saint-Marc-des-Carri\u00e8res' >Saint-Marc-des-Carri\u00e8res<\/option><option value='Saint-Marc-du-Lac-Long' >Saint-Marc-du-Lac-Long<\/option><option value='Saint-Marc-sur-Richelieu' >Saint-Marc-sur-Richelieu<\/option><option value='Saint-Marcel' >Saint-Marcel<\/option><option value='Saint-Marcel-de-Richelieu' >Saint-Marcel-de-Richelieu<\/option><option value='Saint-Marcellin' >Saint-Marcellin<\/option><option value='Saint-Martin' >Saint-Martin<\/option><option value='Saint-Mathias-sur-Richelieu' >Saint-Mathias-sur-Richelieu<\/option><option value='Saint-Mathieu' >Saint-Mathieu<\/option><option value='Saint-Mathieu-d&#039;Harricana' >Saint-Mathieu-d&#039;Harricana<\/option><option value='Saint-Mathieu-de-Beloeil' >Saint-Mathieu-de-Beloeil<\/option><option value='Saint-Mathieu-de-Rioux' >Saint-Mathieu-de-Rioux<\/option><option value='Saint-Mathieu-du-Parc' >Saint-Mathieu-du-Parc<\/option><option value='Saint-Maurice' >Saint-Maurice<\/option><option value='Saint-Maxime-du-Mont-Louis' >Saint-Maxime-du-Mont-Louis<\/option><option value='Saint-M\u00e9dard' >Saint-M\u00e9dard<\/option><option value='Saint-Michel' >Saint-Michel<\/option><option value='Saint-Michel-de-Bellechasse' >Saint-Michel-de-Bellechasse<\/option><option value='Saint-Michel-des-Saints' >Saint-Michel-des-Saints<\/option><option value='Saint-Michel-du-Squatec' >Saint-Michel-du-Squatec<\/option><option value='Saint-Modeste' >Saint-Modeste<\/option><option value='Saint-Mo\u00efse' >Saint-Mo\u00efse<\/option><option value='Saint-Narcisse' >Saint-Narcisse<\/option><option value='Saint-Narcisse-de-Beaurivage' >Saint-Narcisse-de-Beaurivage<\/option><option value='Saint-Narcisse-de-Rimouski' >Saint-Narcisse-de-Rimouski<\/option><option value='Saint-Nazaire' >Saint-Nazaire<\/option><option value='Saint-Nazaire-d&#039;Acton' >Saint-Nazaire-d&#039;Acton<\/option><option value='Saint-Nazaire-de-Dorchester' >Saint-Nazaire-de-Dorchester<\/option><option value='Saint-N\u00e9r\u00e9e-de-Bellechasse' >Saint-N\u00e9r\u00e9e-de-Bellechasse<\/option><option value='Saint-No\u00ebl' >Saint-No\u00ebl<\/option><option value='Saint-Norbert' >Saint-Norbert<\/option><option value='Saint-Norbert-d&#039;Arthabaska' >Saint-Norbert-d&#039;Arthabaska<\/option><option value='Saint-Octave-de-M\u00e9tis' >Saint-Octave-de-M\u00e9tis<\/option><option value='Saint-Odilon-de-Cranbourne' >Saint-Odilon-de-Cranbourne<\/option><option value='Saint-Omer' >Saint-Omer<\/option><option value='Saint-On\u00e9sime-d&#039;Ixworth' >Saint-On\u00e9sime-d&#039;Ixworth<\/option><option value='Saint-Ours' >Saint-Ours<\/option><option value='Saint-Pac\u00f4me' >Saint-Pac\u00f4me<\/option><option value='Saint-Pamphile' >Saint-Pamphile<\/option><option value='Saint-Pascal' >Saint-Pascal<\/option><option value='Saint-Patrice-de-Beaurivage' >Saint-Patrice-de-Beaurivage<\/option><option value='Saint-Patrice-de-Sherrington' >Saint-Patrice-de-Sherrington<\/option><option value='Saint-Paul' >Saint-Paul<\/option><option value='Saint-Paul-d&#039;Abbotsford' >Saint-Paul-d&#039;Abbotsford<\/option><option value='Saint-Paul-de-Montminy' >Saint-Paul-de-Montminy<\/option><option value='Saint-Paul-de-l&#039;\u00cele-aux-Noix' >Saint-Paul-de-l&#039;\u00cele-aux-Noix<\/option><option value='Saint-Paul-de-la-Croix' >Saint-Paul-de-la-Croix<\/option><option value='Saint-Paulin' >Saint-Paulin<\/option><option value='Saint-Phil\u00e9mon' >Saint-Phil\u00e9mon<\/option><option value='Saint-Philibert' >Saint-Philibert<\/option><option value='Saint-Philippe' >Saint-Philippe<\/option><option value='Saint-Philippe-de-N\u00e9ri' >Saint-Philippe-de-N\u00e9ri<\/option><option value='Saint-Pie' >Saint-Pie<\/option><option value='Saint-Pie-de-Guire' >Saint-Pie-de-Guire<\/option><option value='Saint-Pierre' >Saint-Pierre<\/option><option value='Saint-Pierre-Baptiste' >Saint-Pierre-Baptiste<\/option><option value='Saint-Pierre-de-Broughton' >Saint-Pierre-de-Broughton<\/option><option value='Saint-Pierre-de-Lamy' >Saint-Pierre-de-Lamy<\/option><option value='Saint-Pierre-de-l&#039;\u00cele-d&#039;Orl\u00e9ans' >Saint-Pierre-de-l&#039;\u00cele-d&#039;Orl\u00e9ans<\/option><option value='Saint-Pierre-de-la-Rivi\u00e8re-du-Sud' >Saint-Pierre-de-la-Rivi\u00e8re-du-Sud<\/option><option value='Saint-Pierre-les-Becquets' >Saint-Pierre-les-Becquets<\/option><option value='Saint-Placide' >Saint-Placide<\/option><option value='Saint-Polycarpe' >Saint-Polycarpe<\/option><option value='Saint-Prime' >Saint-Prime<\/option><option value='Saint-Prosper' >Saint-Prosper<\/option><option value='Saint-Prosper-de-Champlain' >Saint-Prosper-de-Champlain<\/option><option value='Saint-Rapha\u00ebl' >Saint-Rapha\u00ebl<\/option><option value='Saint-Raymond' >Saint-Raymond<\/option><option value='Saint-R\u00e9mi' >Saint-R\u00e9mi<\/option><option value='Saint-R\u00e9mi-de-Tingwick' >Saint-R\u00e9mi-de-Tingwick<\/option><option value='Saint-Ren\u00e9' >Saint-Ren\u00e9<\/option><option value='Saint-Ren\u00e9-de-Matane' >Saint-Ren\u00e9-de-Matane<\/option><option value='Saint-Robert' >Saint-Robert<\/option><option value='Saint-Robert-Bellarmin' >Saint-Robert-Bellarmin<\/option><option value='Saint-Roch-Ouest' >Saint-Roch-Ouest<\/option><option value='Saint-Roch-de-M\u00e9kinac' >Saint-Roch-de-M\u00e9kinac<\/option><option value='Saint-Roch-de-Richelieu' >Saint-Roch-de-Richelieu<\/option><option value='Saint-Roch-de-l&#039;Achigan' >Saint-Roch-de-l&#039;Achigan<\/option><option value='Saint-Roch-des-Aulnaies' >Saint-Roch-des-Aulnaies<\/option><option value='Saint-Romain' >Saint-Romain<\/option><option value='Saint-Rosaire' >Saint-Rosaire<\/option><option value='Saint-Samuel' >Saint-Samuel<\/option><option value='Saint-Sauveur' >Saint-Sauveur<\/option><option value='Saint-S\u00e9bastien' >Saint-S\u00e9bastien<\/option><option value='Saint-S\u00e9v\u00e8re' >Saint-S\u00e9v\u00e8re<\/option><option value='Saint-S\u00e9verin' >Saint-S\u00e9verin<\/option><option value='Saint-Sim\u00e9on' >Saint-Sim\u00e9on<\/option><option value='Saint-Simon' >Saint-Simon<\/option><option value='Saint-Simon-les-Mines' >Saint-Simon-les-Mines<\/option><option value='Saint-Sixte' >Saint-Sixte<\/option><option value='Saint-Stanislas' >Saint-Stanislas<\/option><option value='Saint-Stanislas-de-Kostka' >Saint-Stanislas-de-Kostka<\/option><option value='Saint-Sulpice' >Saint-Sulpice<\/option><option value='Saint-Sylv\u00e8re' >Saint-Sylv\u00e8re<\/option><option value='Saint-Sylvestre' >Saint-Sylvestre<\/option><option value='Saint-T\u00e9lesphore' >Saint-T\u00e9lesphore<\/option><option value='Saint-Tharcisius' >Saint-Tharcisius<\/option><option value='Saint-Th\u00e9odore-d&#039;Acton' >Saint-Th\u00e9odore-d&#039;Acton<\/option><option value='Saint-Th\u00e9ophile' >Saint-Th\u00e9ophile<\/option><option value='Saint-Thomas' >Saint-Thomas<\/option><option value='Saint-Thomas-Didyme' >Saint-Thomas-Didyme<\/option><option value='Saint-Thuribe' >Saint-Thuribe<\/option><option value='Saint-Tite' >Saint-Tite<\/option><option value='Saint-Tite-des-Caps' >Saint-Tite-des-Caps<\/option><option value='Saint-Ubalde' >Saint-Ubalde<\/option><option value='Saint-Ulric' >Saint-Ulric<\/option><option value='Saint-Valentin' >Saint-Valentin<\/option><option value='Saint-Val\u00e8re' >Saint-Val\u00e8re<\/option><option value='Saint-Val\u00e9rien' >Saint-Val\u00e9rien<\/option><option value='Saint-Val\u00e9rien-de-Milton' >Saint-Val\u00e9rien-de-Milton<\/option><option value='Saint-Vallier' >Saint-Vallier<\/option><option value='Saint-Venant-de-Paquette' >Saint-Venant-de-Paquette<\/option><option value='Saint-Vianney' >Saint-Vianney<\/option><option value='Saint-Victor' >Saint-Victor<\/option><option value='Saint-Wenceslas' >Saint-Wenceslas<\/option><option value='Saint-Zacharie' >Saint-Zacharie<\/option><option value='Saint-Z\u00e9non' >Saint-Z\u00e9non<\/option><option value='Saint-Z\u00e9non-du-Lac-Humqui' >Saint-Z\u00e9non-du-Lac-Humqui<\/option><option value='Saint-Z\u00e9phirin-de-Courval' >Saint-Z\u00e9phirin-de-Courval<\/option><option value='Saint-Zotique' >Saint-Zotique<\/option><option value='Sainte-Ad\u00e8le' >Sainte-Ad\u00e8le<\/option><option value='Sainte-Agathe-de-Lotbini\u00e8re' >Sainte-Agathe-de-Lotbini\u00e8re<\/option><option value='Sainte-Agathe-des-Monts' >Sainte-Agathe-des-Monts<\/option><option value='Sainte-Ang\u00e8le-de-M\u00e9rici' >Sainte-Ang\u00e8le-de-M\u00e9rici<\/option><option value='Sainte-Ang\u00e8le-de-Monnoir' >Sainte-Ang\u00e8le-de-Monnoir<\/option><option value='Sainte-Ang\u00e8le-de-Pr\u00e9mont' >Sainte-Ang\u00e8le-de-Pr\u00e9mont<\/option><option value='Sainte-Anne-de-Beaupr\u00e9' >Sainte-Anne-de-Beaupr\u00e9<\/option><option value='Sainte-Anne-de-Bellevue' >Sainte-Anne-de-Bellevue<\/option><option value='Sainte-Anne-de-Sabrevois' >Sainte-Anne-de-Sabrevois<\/option><option value='Sainte-Anne-de-Sorel' >Sainte-Anne-de-Sorel<\/option><option value='Sainte-Anne-de-la-P\u00e9rade' >Sainte-Anne-de-la-P\u00e9rade<\/option><option value='Sainte-Anne-de-la-Pocati\u00e8re' >Sainte-Anne-de-la-Pocati\u00e8re<\/option><option value='Sainte-Anne-de-la-Rochelle' >Sainte-Anne-de-la-Rochelle<\/option><option value='Sainte-Anne-des-Lacs' >Sainte-Anne-des-Lacs<\/option><option value='Sainte-Anne-des-Monts' >Sainte-Anne-des-Monts<\/option><option value='Sainte-Anne-des-Plaines' >Sainte-Anne-des-Plaines<\/option><option value='Sainte-Anne-du-Lac' >Sainte-Anne-du-Lac<\/option><option value='Sainte-Apolline-de-Patton' >Sainte-Apolline-de-Patton<\/option><option value='Sainte-Aur\u00e9lie' >Sainte-Aur\u00e9lie<\/option><option value='Sainte-Barbe' >Sainte-Barbe<\/option><option value='Sainte-B\u00e9atrix' >Sainte-B\u00e9atrix<\/option><option value='Sainte-Brigide-d&#039;Iberville' >Sainte-Brigide-d&#039;Iberville<\/option><option value='Sainte-Brigitte-de-Laval' >Sainte-Brigitte-de-Laval<\/option><option value='Sainte-Brigitte-des-Saults' >Sainte-Brigitte-des-Saults<\/option><option value='Sainte-Catherine' >Sainte-Catherine<\/option><option value='Sainte-Catherine-de-Hatley' >Sainte-Catherine-de-Hatley<\/option><option value='Sainte-Catherine-de-la-Jacques-Cartier' >Sainte-Catherine-de-la-Jacques-Cartier<\/option><option value='Sainte-C\u00e9cile-de-L\u00e9vrard' >Sainte-C\u00e9cile-de-L\u00e9vrard<\/option><option value='Sainte-C\u00e9cile-de-Milton' >Sainte-C\u00e9cile-de-Milton<\/option><option value='Sainte-C\u00e9cile-de-Whitton' >Sainte-C\u00e9cile-de-Whitton<\/option><option value='Sainte-Christine' >Sainte-Christine<\/option><option value='Sainte-Christine-d&#039;Auvergne' >Sainte-Christine-d&#039;Auvergne<\/option><option value='Sainte-Claire' >Sainte-Claire<\/option><option value='Sainte-Clotilde' >Sainte-Clotilde<\/option><option value='Sainte-Clotilde-de-Beauce' >Sainte-Clotilde-de-Beauce<\/option><option value='Sainte-Clotilde-de-Horton' >Sainte-Clotilde-de-Horton<\/option><option value='Sainte-Croix' >Sainte-Croix<\/option><option value='Sainte-Edwidge-de-Clifton' >Sainte-Edwidge-de-Clifton<\/option><option value='Sainte-\u00c9lisabeth' >Sainte-\u00c9lisabeth<\/option><option value='Sainte-\u00c9lizabeth-de-Warwick' >Sainte-\u00c9lizabeth-de-Warwick<\/option><option value='Sainte-\u00c9m\u00e9lie-de-l&#039;\u00c9nergie' >Sainte-\u00c9m\u00e9lie-de-l&#039;\u00c9nergie<\/option><option value='Sainte-Eulalie' >Sainte-Eulalie<\/option><option value='Sainte-Euph\u00e9mie-sur-Rivi\u00e8re-du-Sud' >Sainte-Euph\u00e9mie-sur-Rivi\u00e8re-du-Sud<\/option><option value='Sainte-Famille-de-l\u2019\u00cele-d\u2019Orl\u00e9ans' >Sainte-Famille-de-l\u2019\u00cele-d\u2019Orl\u00e9ans<\/option><option value='Sainte-F\u00e9licit\u00e9' >Sainte-F\u00e9licit\u00e9<\/option><option value='Sainte-Flavie' >Sainte-Flavie<\/option><option value='Sainte-Florence' >Sainte-Florence<\/option><option value='Sainte-Fran\u00e7oise' >Sainte-Fran\u00e7oise<\/option><option value='Sainte-Fran\u00e7oise' >Sainte-Fran\u00e7oise<\/option><option value='Sainte-Genevi\u00e8ve-de-Batiscan' >Sainte-Genevi\u00e8ve-de-Batiscan<\/option><option value='Sainte-Genevi\u00e8ve-de-Berthier' >Sainte-Genevi\u00e8ve-de-Berthier<\/option><option value='Sainte-Germaine-Boul\u00e9' >Sainte-Germaine-Boul\u00e9<\/option><option value='Sainte-Gertrude-Manneville' >Sainte-Gertrude-Manneville<\/option><option value='Sainte-Hedwidge' >Sainte-Hedwidge<\/option><option value='Sainte-H\u00e9l\u00e8ne-de-Bagot' >Sainte-H\u00e9l\u00e8ne-de-Bagot<\/option><option value='Sainte-H\u00e9l\u00e8ne-de-Chester' >Sainte-H\u00e9l\u00e8ne-de-Chester<\/option><option value='Sainte-H\u00e9l\u00e8ne-de-Kamouraska' >Sainte-H\u00e9l\u00e8ne-de-Kamouraska<\/option><option value='Sainte-H\u00e9l\u00e8ne-de-Mancebourg' >Sainte-H\u00e9l\u00e8ne-de-Mancebourg<\/option><option value='Sainte-H\u00e9n\u00e9dine' >Sainte-H\u00e9n\u00e9dine<\/option><option value='Sainte-Ir\u00e8ne' >Sainte-Ir\u00e8ne<\/option><option value='Sainte-Jeanne-d&#039;Arc' >Sainte-Jeanne-d&#039;Arc<\/option><option value='Sainte-Jeanne-d&#039;Arc' >Sainte-Jeanne-d&#039;Arc<\/option><option value='Sainte-Julie' >Sainte-Julie<\/option><option value='Sainte-Julienne' >Sainte-Julienne<\/option><option value='Sainte-Justine' >Sainte-Justine<\/option><option value='Sainte-Justine-de-Newton' >Sainte-Justine-de-Newton<\/option><option value='Sainte-Louise' >Sainte-Louise<\/option><option value='Sainte-Luce' >Sainte-Luce<\/option><option value='Sainte-Lucie-de-Beauregard' >Sainte-Lucie-de-Beauregard<\/option><option value='Sainte-Lucie-des-Laurentides' >Sainte-Lucie-des-Laurentides<\/option><option value='Sainte-Madeleine' >Sainte-Madeleine<\/option><option value='Sainte-Madeleine-de-la-Rivi\u00e8re-Madeleine' >Sainte-Madeleine-de-la-Rivi\u00e8re-Madeleine<\/option><option value='Sainte-Marcelline-de-Kildare' >Sainte-Marcelline-de-Kildare<\/option><option value='Sainte-Marguerite' >Sainte-Marguerite<\/option><option value='Sainte-Marguerite-Marie' >Sainte-Marguerite-Marie<\/option><option value='Sainte-Marguerite-du-Lac-Masson' >Sainte-Marguerite-du-Lac-Masson<\/option><option value='Sainte-Marie' >Sainte-Marie<\/option><option value='Sainte-Marie-Madeleine' >Sainte-Marie-Madeleine<\/option><option value='Sainte-Marie-Salom\u00e9' >Sainte-Marie-Salom\u00e9<\/option><option value='Sainte-Marie-de-Blandford' >Sainte-Marie-de-Blandford<\/option><option value='Sainte-Marthe' >Sainte-Marthe<\/option><option value='Sainte-Marthe-sur-le-Lac' >Sainte-Marthe-sur-le-Lac<\/option><option value='Sainte-Martine' >Sainte-Martine<\/option><option value='Sainte-M\u00e9lanie' >Sainte-M\u00e9lanie<\/option><option value='Sainte-Monique' >Sainte-Monique<\/option><option value='Sainte-Monique' >Sainte-Monique<\/option><option value='Sainte-Paule' >Sainte-Paule<\/option><option value='Sainte-Perp\u00e9tue' >Sainte-Perp\u00e9tue<\/option><option value='Sainte-P\u00e9tronille' >Sainte-P\u00e9tronille<\/option><option value='Sainte-Prax\u00e8de' >Sainte-Prax\u00e8de<\/option><option value='Sainte-Rita' >Sainte-Rita<\/option><option value='Sainte-Rose-de-Watford' >Sainte-Rose-de-Watford<\/option><option value='Sainte-Rose-du-Nord' >Sainte-Rose-du-Nord<\/option><option value='Sainte-Sabine' >Sainte-Sabine<\/option><option value='Sainte-S\u00e9raphine' >Sainte-S\u00e9raphine<\/option><option value='Sainte-Sophie' >Sainte-Sophie<\/option><option value='Sainte-Sophie-d&#039;Halifax' >Sainte-Sophie-d&#039;Halifax<\/option><option value='Sainte-Sophie-de-L\u00e9vrard' >Sainte-Sophie-de-L\u00e9vrard<\/option><option value='Sainte-Th\u00e8cle' >Sainte-Th\u00e8cle<\/option><option value='Sainte-Th\u00e9r\u00e8se' >Sainte-Th\u00e9r\u00e8se<\/option><option value='Sainte-Th\u00e9r\u00e8se-de-Gasp\u00e9' >Sainte-Th\u00e9r\u00e8se-de-Gasp\u00e9<\/option><option value='Sainte-Th\u00e9r\u00e8se-de-la-Gatineau' >Sainte-Th\u00e9r\u00e8se-de-la-Gatineau<\/option><option value='Sainte-Ursule' >Sainte-Ursule<\/option><option value='Sainte-Victoire-de-Sorel' >Sainte-Victoire-de-Sorel<\/option><option value='Saints-Anges' >Saints-Anges<\/option><option value='Saints-Martyrs-Canadiens' >Saints-Martyrs-Canadiens<\/option><option value='Salaberry-de-Valleyfield' >Salaberry-de-Valleyfield<\/option><option value='Salluit' >Salluit<\/option><option value='Sayabec' >Sayabec<\/option><option value='Schefferville' >Schefferville<\/option><option value='Scotstown' >Scotstown<\/option><option value='Scott' >Scott<\/option><option value='Senneterre' >Senneterre<\/option><option value='Senneville' >Senneville<\/option><option value='Sept-\u00celes' >Sept-\u00celes<\/option><option value='Sept-Rivi\u00e8res' >Sept-Rivi\u00e8res<\/option><option value='Shannon' >Shannon<\/option><option value='Shawinigan' >Shawinigan<\/option><option value='Shawville' >Shawville<\/option><option value='Sheenboro' >Sheenboro<\/option><option value='Shefford' >Shefford<\/option><option value='Sherbrooke' >Sherbrooke<\/option><option value='Shigawake' >Shigawake<\/option><option value='Sorel-Tracy' >Sorel-Tracy<\/option><option value='Stanbridge East' >Stanbridge East<\/option><option value='Stanbridge Station' >Stanbridge Station<\/option><option value='Stanstead' >Stanstead<\/option><option value='Stanstead-Est' >Stanstead-Est<\/option><option value='Stoke' >Stoke<\/option><option value='Stoneham-et-Tewkesbury' >Stoneham-et-Tewkesbury<\/option><option value='Stornoway' >Stornoway<\/option><option value='Stratford' >Stratford<\/option><option value='Stukely-Sud' >Stukely-Sud<\/option><option value='Sutton' >Sutton<\/option><option value='Tadoussac' >Tadoussac<\/option><option value='Taschereau' >Taschereau<\/option><option value='Tasiujaq' >Tasiujaq<\/option><option value='T\u00e9miscaming' >T\u00e9miscaming<\/option><option value='T\u00e9miscamingue' >T\u00e9miscamingue<\/option><option value='T\u00e9miscouata' >T\u00e9miscouata<\/option><option value='T\u00e9miscouata-sur-le-Lac' >T\u00e9miscouata-sur-le-Lac<\/option><option value='Terrasse-Vaudreuil' >Terrasse-Vaudreuil<\/option><option value='Terrebonne' >Terrebonne<\/option><option value='Th\u00e9r\u00e8se-De Blainville' >Th\u00e9r\u00e8se-De Blainville<\/option><option value='Thetford Mines' >Thetford Mines<\/option><option value='Thorne' >Thorne<\/option><option value='Thurso' >Thurso<\/option><option value='Tingwick' >Tingwick<\/option><option value='Tourville' >Tourville<\/option><option value='Tr\u00e9cesson' >Tr\u00e9cesson<\/option><option value='Tr\u00e8s-Saint-R\u00e9dempteur' >Tr\u00e8s-Saint-R\u00e9dempteur<\/option><option value='Tr\u00e8s-Saint-Sacrement' >Tr\u00e8s-Saint-Sacrement<\/option><option value='Tring-Jonction' >Tring-Jonction<\/option><option value='Trois-Pistoles' >Trois-Pistoles<\/option><option value='Trois-Rives' >Trois-Rives<\/option><option value='Trois-Rivi\u00e8res' >Trois-Rivi\u00e8res<\/option><option value='Ulverton' >Ulverton<\/option><option value='Umiujaq' >Umiujaq<\/option><option value='Upton' >Upton<\/option><option value='Val-Alain' >Val-Alain<\/option><option value='Val-Brillant' >Val-Brillant<\/option><option value='Val-David' >Val-David<\/option><option value='Val-Joli' >Val-Joli<\/option><option value='Val-Morin' >Val-Morin<\/option><option value='Val-Racine' >Val-Racine<\/option><option value='Val-Saint-Gilles' >Val-Saint-Gilles<\/option><option value='Val-d&#039;Or' >Val-d&#039;Or<\/option><option value='Val-des-Bois' >Val-des-Bois<\/option><option value='Val-des-Lacs' >Val-des-Lacs<\/option><option value='Val-des-Monts' >Val-des-Monts<\/option><option value='Valcourt' >Valcourt<\/option><option value='Valcourt' >Valcourt<\/option><option value='Vall\u00e9e-Jonction' >Vall\u00e9e-Jonction<\/option><option value='Varennes' >Varennes<\/option><option value='Vaudreuil-Dorion' >Vaudreuil-Dorion<\/option><option value='Vaudreuil-Soulanges' >Vaudreuil-Soulanges<\/option><option value='Vaudreuil-sur-le-Lac' >Vaudreuil-sur-le-Lac<\/option><option value='Venise-en-Qu\u00e9bec' >Venise-en-Qu\u00e9bec<\/option><option value='Verch\u00e8res' >Verch\u00e8res<\/option><option value='Victoriaville' >Victoriaville<\/option><option value='Ville-Marie' >Ville-Marie<\/option><option value='Villeroy' >Villeroy<\/option><option value='Waltham' >Waltham<\/option><option value='Warden' >Warden<\/option><option value='Warwick' >Warwick<\/option><option value='Waskaganish' >Waskaganish<\/option><option value='Waswanipi' >Waswanipi<\/option><option value='Waterloo' >Waterloo<\/option><option value='Waterville' >Waterville<\/option><option value='Weedon' >Weedon<\/option><option value='Wemindji' >Wemindji<\/option><option value='Wentworth' >Wentworth<\/option><option value='Wentworth-Nord' >Wentworth-Nord<\/option><option value='Westbury' >Westbury<\/option><option value='Westmount' >Westmount<\/option><option value='Whapmagoostui' >Whapmagoostui<\/option><option value='Wickham' >Wickham<\/option><option value='Windsor' >Windsor<\/option><option value='Wotton' >Wotton<\/option><option value='Yamachiche' >Yamachiche<\/option><option value='Yamaska' >Yamaska<\/option><\/select><\/div><\/div><fieldset id=\"field_1_105\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4V &#8211; R\u00e9gion de la violence, ville<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_105'><div class='gchoice gchoice_1_105_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_105.1' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_105_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_105_1' id='label_1_105_1' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_110' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_1_110' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_5' class='gform_page' data-js='page-field-id-110' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_112\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">5. IDENTIFICATION OF THE PERPETRATOR(S) <\/h3><\/div><div id=\"field_1_111\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">How many people do you identify as perpetrators of this violence or abuse?*<\/h3><\/div><fieldset id=\"field_1_113\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >5V &#8211; Nombre de personne<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_113'>\n\t\t\t<div class='gchoice gchoice_1_113_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_113' type='radio' value='Une personne'  id='choice_1_113_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_113_0' id='label_1_113_0' class='gform-field-label gform-field-label--type-inline'>One person<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_113_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_113' type='radio' value='Plusieurs personnes'  id='choice_1_113_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_113_1' id='label_1_113_1' class='gform-field-label gform-field-label--type-inline'>Several people<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_113_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_113' type='radio' value='Une institution ou un syst\u00e8me de la soci\u00e9t\u00e9'  id='choice_1_113_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_113_2' id='label_1_113_2' class='gform-field-label gform-field-label--type-inline'>An institution or a system<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_118\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">One person <\/h3><\/div><div id=\"field_1_185\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Select the answer(s) that best describe this person*<\/h3><\/div><fieldset id=\"field_1_114\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5V &#8211; Une personne, Qui<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_114'><div class='gchoice gchoice_1_114_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.1' type='checkbox'  value='Membre de ma famille'  id='choice_1_114_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_1' id='label_1_114_1' class='gform-field-label gform-field-label--type-inline'>A member of my family<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.2' type='checkbox'  value='Avec qui je suis en relation d\u2019amiti\u00e9'  id='choice_1_114_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_2' id='label_1_114_2' class='gform-field-label gform-field-label--type-inline'>A friend<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.3' type='checkbox'  value='Avec qui j&#039;ai \u00e9t\u00e9 dans une relation d&#039;amiti\u00e9 qui a pris fin avant les \u00e9v\u00e9nements d\u00e9nonc\u00e9s'  id='choice_1_114_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_3' id='label_1_114_3' class='gform-field-label gform-field-label--type-inline'>Someone I was friend with prior to the violence situation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.4' type='checkbox'  value='Avec qui je suis en en relation intime, amoureuse ou sexuelle'  id='choice_1_114_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_4' id='label_1_114_4' class='gform-field-label gform-field-label--type-inline'>Someone with whom I am in a loving, intimate or sexual relationship<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.5' type='checkbox'  value='Avec qui j&#039;ai \u00e9t\u00e9 en relation intime, amoureuse ou sexuelle qui a pris fin avant les \u00e9v\u00e9nements d\u00e9nonc\u00e9s'  id='choice_1_114_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_5' id='label_1_114_5' class='gform-field-label gform-field-label--type-inline'>Someone with whom I was in a loving, intimate or sexual relationship prior to the violent situation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.6' type='checkbox'  value='Qui d\u00e9tient une autorit\u00e9 parentale ou l\u00e9gale sur moi'  id='choice_1_114_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_6' id='label_1_114_6' class='gform-field-label gform-field-label--type-inline'>Someone with a parental or legal authority over me<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.7' type='checkbox'  value='Envers qui j&#039;ai une responsabilit\u00e9 parentale ou l\u00e9gale'  id='choice_1_114_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_7' id='label_1_114_7' class='gform-field-label gform-field-label--type-inline'>Someone over whom I have a parental or legal authority<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.8' type='checkbox'  value='Avec qui j&#039;ai des enfants'  id='choice_1_114_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_8' id='label_1_114_8' class='gform-field-label gform-field-label--type-inline'>With whom I have kid(s)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.9' type='checkbox'  value='Avec qui je suis en colocation'  id='choice_1_114_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_9' id='label_1_114_9' class='gform-field-label gform-field-label--type-inline'>Roomate<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.11' type='checkbox'  value='Chez qui je demeure ou qui m&#039;h\u00e9berge actuellement'  id='choice_1_114_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_11' id='label_1_114_11' class='gform-field-label gform-field-label--type-inline'>With whom I&#8217;m living or who are hosting me at the moment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.12' type='checkbox'  value='Qui est propri\u00e9taire de l&#039;endroit o\u00f9 je r\u00e9side'  id='choice_1_114_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_12' id='label_1_114_12' class='gform-field-label gform-field-label--type-inline'>A property owner or manager<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.13' type='checkbox'  value='Que je c\u00f4toie au travail'  id='choice_1_114_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_13' id='label_1_114_13' class='gform-field-label gform-field-label--type-inline'>People I&#8217;m seeing at work<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.14' type='checkbox'  value='Qui me supervise dans le cadre du travail'  id='choice_1_114_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_14' id='label_1_114_14' class='gform-field-label gform-field-label--type-inline'>Someone who supervises me at work<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.15' type='checkbox'  value='Que je c\u00f4toie \u00e0 l\u2019\u00e9cole'  id='choice_1_114_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_15' id='label_1_114_15' class='gform-field-label gform-field-label--type-inline'>People I&#8217;m seeing at school<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.16' type='checkbox'  value='Qui travaille dans un \u00e9tablissement d\u2019enseignement'  id='choice_1_114_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_16' id='label_1_114_16' class='gform-field-label gform-field-label--type-inline'>Someone who works in an educational institution<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.17' type='checkbox'  value='Qui travaille dans le domaine de la sant\u00e9 et des services sociaux'  id='choice_1_114_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_17' id='label_1_114_17' class='gform-field-label gform-field-label--type-inline'>Someone who works in health and social services<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.18' type='checkbox'  value='Qui travaille dans le milieu communautaire'  id='choice_1_114_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_18' id='label_1_114_18' class='gform-field-label gform-field-label--type-inline'>Someone who works in a community organization<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.19' type='checkbox'  value='Qui travaille dans le domaine juridique'  id='choice_1_114_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_19' id='label_1_114_19' class='gform-field-label gform-field-label--type-inline'>Someone who works in the legal or judicial field<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.21' type='checkbox'  value='Qui travaille dans le domaine sportif'  id='choice_1_114_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_21' id='label_1_114_21' class='gform-field-label gform-field-label--type-inline'>Someone who works in the sports field<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.22' type='checkbox'  value='Qui travaille dans les forces de police'  id='choice_1_114_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_22' id='label_1_114_22' class='gform-field-label gform-field-label--type-inline'>Someone who works for the police<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.23' type='checkbox'  value='Qui travaille en politique'  id='choice_1_114_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_23' id='label_1_114_23' class='gform-field-label gform-field-label--type-inline'>Someone who works in politics\/is an elected official<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.24' type='checkbox'  value='Connue du public'  id='choice_1_114_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_24' id='label_1_114_24' class='gform-field-label gform-field-label--type-inline'>A public figure<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.25' type='checkbox'  value='Inconnue ou que je connais peu'  id='choice_1_114_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_25' id='label_1_114_25' class='gform-field-label gform-field-label--type-inline'>A stranger or someone I don&#8217;t really know<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.26' type='checkbox'  value='Je ne sais pas'  id='choice_1_114_26'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_26' id='label_1_114_26' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_27'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.27' type='checkbox'  value='Autre (pr\u00e9ciser)'  id='choice_1_114_27'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_27' id='label_1_114_27' class='gform-field-label gform-field-label--type-inline'>Other(s) (Please specify)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_114_28'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_114.28' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_114_28'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_114_28' id='label_1_114_28' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='mm_tooltip_text' style='display:none'><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><p>FR : Par exemple, membre du personnel enseignant, membre de la direction, etc. | EN : For example a teacher, a principal, etc.<\/p><hr \/><p>FR : Par exemple, m\u00e9decin, membre du personnel infirmier, personne pr\u00e9pos\u00e9e aux b\u00e9n\u00e9ficiaires, etc. | EN : For example a doctor, a nurse, a medical secretary, etc.\u00a0<\/p><hr \/><p>FR : Par exemple, membre du personnel intervenant dans un organisme communautaire, etc. | EN : For example a counsellor affiliated to a community organization<\/p><hr \/><p>FR : Par exemple, personne avocate, juge, procureure, douani\u00e8re, etc. | EN : For example a lawyer, a judge, a customs agent, etc.<\/p><\/div><\/fieldset><div id=\"field_1_119\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_119'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_119' id='input_1_119' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_121\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Do you consider that the perpetrator was in a position of authority over you? <\/h3><\/div><fieldset id=\"field_1_115\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >5V &#8211; Une personne, Position d&#039;autorit\u00e9<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_115'>\n\t\t\t<div class='gchoice gchoice_1_115_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_115' type='radio' value='Oui (pr\u00e9ciser)'  id='choice_1_115_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_115_0' id='label_1_115_0' class='gform-field-label gform-field-label--type-inline'>Yes (Please specify)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_115_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_115' type='radio' value='Non'  id='choice_1_115_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_115_1' id='label_1_115_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_115_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_115' type='radio' value='Je ne sais pas'  id='choice_1_115_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_115_2' id='label_1_115_2' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_115_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_115' type='radio' value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_115_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_115_3' id='label_1_115_3' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_120\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_120'>Please specify if your answer is yes<\/label><div class='ginput_container ginput_container_text'><input name='input_120' id='input_1_120' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_122\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Which of these categories best correspond to the known or approximate age of the perpetrator?<\/h3><\/div><fieldset id=\"field_1_116\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >5V &#8211; Une personne, \u00c2ge<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_116'>\n\t\t\t<div class='gchoice gchoice_1_116_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='Moins de 12 ans'  id='choice_1_116_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_116_0' id='label_1_116_0' class='gform-field-label gform-field-label--type-inline'>Under 12 years old<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_116_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='Entre 12 et 17 ans'  id='choice_1_116_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_116_1' id='label_1_116_1' class='gform-field-label gform-field-label--type-inline'>12 to 17 years old<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_116_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='Entre 18 et 30 ans'  id='choice_1_116_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_116_2' id='label_1_116_2' class='gform-field-label gform-field-label--type-inline'>18 to 30 years old<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_116_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='Entre 31 et 59 ans'  id='choice_1_116_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_116_3' id='label_1_116_3' class='gform-field-label gform-field-label--type-inline'>31 to 59 years old<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_116_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='60 ans et plus'  id='choice_1_116_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_116_4' id='label_1_116_4' class='gform-field-label gform-field-label--type-inline'>60 years old and over<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_116_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_116' type='radio' value='Je ne sais pas'  id='choice_1_116_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_116_5' id='label_1_116_5' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_123\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Does the perpetrator identify as an LGBTQI+ person? <\/h3><\/div><fieldset id=\"field_1_117\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >5V &#8211; Une personne, LGBTQI+<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_117'>\n\t\t\t<div class='gchoice gchoice_1_117_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_117' type='radio' value='Oui, je sais que cette personne fait partie des communaut\u00e9s LGBTQI+'  id='choice_1_117_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_117_0' id='label_1_117_0' class='gform-field-label gform-field-label--type-inline'>Yes, I know that this person identifies as an LGBTQI+ person <\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_117_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_117' type='radio' value='Non, je sais que cette personne n\u2019en fait pas partie'  id='choice_1_117_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_117_1' id='label_1_117_1' class='gform-field-label gform-field-label--type-inline'>No, I know that this person does not identify as an LGBTQI+ person<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_117_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_117' type='radio' value='Je ne sais pas'  id='choice_1_117_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_117_2' id='label_1_117_2' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_117_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_117' type='radio' value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_117_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_117_3' id='label_1_117_3' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_124\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Several people <\/h3><\/div><div id=\"field_1_128\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Enter the number of people you identify as perpetrators of this violence or abuse?<\/h3><\/div><div id=\"field_1_127\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_127'>5V &#8211; Plusieurs personnes, Nombre<\/label><div class='ginput_container ginput_container_number'><input name='input_127' id='input_1_127' type='number' step='any' min='2'  value='' class='large'      aria-invalid=\"false\" aria-describedby=\"gfield_instruction_1_127\" \/><div class='gfield_description instruction ' id='gfield_instruction_1_127'>Please enter a number greater than or equal to <strong>2<\/strong>.<\/div><\/div><\/div><div id=\"field_1_186\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Select the answer(s) that best describe these people*<\/h3><\/div><fieldset id=\"field_1_125\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5V &#8211; Plusieurs personne, Qui<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_125'><div class='gchoice gchoice_1_125_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.1' type='checkbox'  value='Membres de ma famille'  id='choice_1_125_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_1' id='label_1_125_1' class='gform-field-label gform-field-label--type-inline'>Member(s)  of my family<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.2' type='checkbox'  value='Qui d\u00e9tient une autorit\u00e9 parentale ou l\u00e9gale sur moi'  id='choice_1_125_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_2' id='label_1_125_2' class='gform-field-label gform-field-label--type-inline'>People with a parental or legal authority over me<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.3' type='checkbox'  value='Envers qui j&#039;ai une responsabilit\u00e9 parentale ou l\u00e9gale'  id='choice_1_125_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_3' id='label_1_125_3' class='gform-field-label gform-field-label--type-inline'>People over whom I have a parental or legal authority<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.4' type='checkbox'  value='Avec qui je suis en relation d\u2019amiti\u00e9'  id='choice_1_125_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_4' id='label_1_125_4' class='gform-field-label gform-field-label--type-inline'>Friends<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.5' type='checkbox'  value='Avec qui j&#039;ai \u00e9t\u00e9 en relation d&#039;amiti\u00e9 mais qui a pris fin avant les \u00e9v\u00e9nements d\u00e9nonc\u00e9s'  id='choice_1_125_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_5' id='label_1_125_5' class='gform-field-label gform-field-label--type-inline'>With whom I used to be friends prior to the violence situation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.6' type='checkbox'  value='Avec qui je suis en relation intime, amoureuse ou sexuelle'  id='choice_1_125_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_6' id='label_1_125_6' class='gform-field-label gform-field-label--type-inline'>People with whom I am in a loving, intimate or sexual relationships<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.7' type='checkbox'  value='Avec qui j&#039;ai \u00e9t\u00e9 en relation intime, amoureuse ou sexuelle mais qui a pris fin avant les \u00e9v\u00e9nements d\u00e9nonc\u00e9s'  id='choice_1_125_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_7' id='label_1_125_7' class='gform-field-label gform-field-label--type-inline'>People with whom I used to be in a loving, intimate or sexual relationships prior to the violence situation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.8' type='checkbox'  value='Avec qui j&#039;ai des enfants'  id='choice_1_125_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_8' id='label_1_125_8' class='gform-field-label gform-field-label--type-inline'>With whom I have kid(s)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.9' type='checkbox'  value='Avec qui je suis en colocation'  id='choice_1_125_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_9' id='label_1_125_9' class='gform-field-label gform-field-label--type-inline'>Roomates<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.11' type='checkbox'  value='Chez qui je demeure ou qui m&#039;h\u00e9berge actuellement'  id='choice_1_125_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_11' id='label_1_125_11' class='gform-field-label gform-field-label--type-inline'>With whom I&#8217;m living or who are hosting me at the moment<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.12' type='checkbox'  value='Qui est propri\u00e9taire de l&#039;endroit o\u00f9 je vis actuellement'  id='choice_1_125_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_12' id='label_1_125_12' class='gform-field-label gform-field-label--type-inline'>Property owners or managers<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.13' type='checkbox'  value='Que je c\u00f4toie au travail'  id='choice_1_125_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_13' id='label_1_125_13' class='gform-field-label gform-field-label--type-inline'>People I&#8217;m seeing at work<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.14' type='checkbox'  value='Qui me supervisent dans le cadre du travail'  id='choice_1_125_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_14' id='label_1_125_14' class='gform-field-label gform-field-label--type-inline'>People who supervise me at work<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.15' type='checkbox'  value='Que je c\u00f4toie \u00e0 l\u2019\u00e9cole'  id='choice_1_125_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_15' id='label_1_125_15' class='gform-field-label gform-field-label--type-inline'>People I&#8217;m seeing at school<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.16' type='checkbox'  value='Qui travaillent dans un \u00e9tablissement d\u2019enseignement'  id='choice_1_125_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_16' id='label_1_125_16' class='gform-field-label gform-field-label--type-inline'>People working in a school setting<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.17' type='checkbox'  value='Qui travaillent dans le domaine de la sant\u00e9 et des services sociaux'  id='choice_1_125_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_17' id='label_1_125_17' class='gform-field-label gform-field-label--type-inline'>People working in healthcare or social work<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.18' type='checkbox'  value='Qui travaillent dans le milieu communautaire'  id='choice_1_125_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_18' id='label_1_125_18' class='gform-field-label gform-field-label--type-inline'>People working in community organizations<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.19' type='checkbox'  value='Qui travaillent dans le domaine juridique'  id='choice_1_125_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_19' id='label_1_125_19' class='gform-field-label gform-field-label--type-inline'>People working in judicial or legal fields<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.21' type='checkbox'  value='Qui travaillent dans le domaine sportif'  id='choice_1_125_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_21' id='label_1_125_21' class='gform-field-label gform-field-label--type-inline'>People working in sports fields<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.22' type='checkbox'  value='Qui travaillent dans les forces de police'  id='choice_1_125_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_22' id='label_1_125_22' class='gform-field-label gform-field-label--type-inline'>People working in the police<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.23' type='checkbox'  value='Qui travaillent en politique'  id='choice_1_125_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_23' id='label_1_125_23' class='gform-field-label gform-field-label--type-inline'>Politicians and elected officials<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.24' type='checkbox'  value='Connues du public'  id='choice_1_125_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_24' id='label_1_125_24' class='gform-field-label gform-field-label--type-inline'>Public personalities<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.25' type='checkbox'  value='Inconnues ou que je connais peu'  id='choice_1_125_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_25' id='label_1_125_25' class='gform-field-label gform-field-label--type-inline'>Strangers or people I don&#8217;t really know<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.26' type='checkbox'  value='Je ne sais pas'  id='choice_1_125_26'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_26' id='label_1_125_26' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_27'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.27' type='checkbox'  value='Autres (pr\u00e9ciser)'  id='choice_1_125_27'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_27' id='label_1_125_27' class='gform-field-label gform-field-label--type-inline'>Other(s) (Please specify)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_125_28'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_125.28' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_125_28'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_125_28' id='label_1_125_28' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='mm_tooltip_text' style='display:none'><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><hr \/><p>FR : Par exemple, membre du personnel enseignant, membre de la direction, etc. | EN : Teachers, principals, etc.\u00a0<\/p><hr \/><p>FR : Par exemple, m\u00e9decin, membre du personnel infirmier, personne pr\u00e9pos\u00e9e aux b\u00e9n\u00e9ficiaires, etc. | EN : Doctors, nurses, medical secretaries, etc.<\/p><hr \/><p>FR : Par exemple, membre du personnel intervenant dans un organisme communautaire, etc. | EN : For example, counsellors in a community organizations.<\/p><hr \/><p>FR : Par exemple, personne avocate, juge, procureure, douani\u00e8re, etc. | EN : Lawyers, judges, etc.<\/p><\/div><\/fieldset><div id=\"field_1_126\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_126'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_126' id='input_1_126' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_129\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Do you consider that at least one of these people were in a position of authority over you? <\/h3><\/div><fieldset id=\"field_1_130\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >5V &#8211; Plusieurs personnes, Position d&#039;autorit\u00e9<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_130'>\n\t\t\t<div class='gchoice gchoice_1_130_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_130' type='radio' value='Oui (pr\u00e9ciser)'  id='choice_1_130_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_130_0' id='label_1_130_0' class='gform-field-label gform-field-label--type-inline'>Yes (Please specify)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_130_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_130' type='radio' value='Non'  id='choice_1_130_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_130_1' id='label_1_130_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_130_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_130' type='radio' value='Je ne sais pas'  id='choice_1_130_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_130_2' id='label_1_130_2' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_130_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_130' type='radio' value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_130_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_130_3' id='label_1_130_3' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_131\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_131'>Please specify if your answer is yes<\/label><div class='ginput_container ginput_container_text'><input name='input_131' id='input_1_131' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_132\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">An institution or a system*<\/h3><\/div><fieldset id=\"field_1_133\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >5V &#8211; Institution ou syst\u00e8me<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_133'><div class='gchoice gchoice_1_133_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.1' type='checkbox'  value='R\u00e9seau de la sant\u00e9 et des services sociaux'  id='choice_1_133_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_1' id='label_1_133_1' class='gform-field-label gform-field-label--type-inline'>Health system and social services <\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_133_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.2' type='checkbox'  value='R\u00e9seau de l\u2019\u00e9ducation'  id='choice_1_133_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_2' id='label_1_133_2' class='gform-field-label gform-field-label--type-inline'>Education system <\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_133_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.3' type='checkbox'  value='Syst\u00e8me de loisirs publics'  id='choice_1_133_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_3' id='label_1_133_3' class='gform-field-label gform-field-label--type-inline'>Public recreation system <\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_133_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.4' type='checkbox'  value='Syst\u00e8me de services priv\u00e9s'  id='choice_1_133_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_4' id='label_1_133_4' class='gform-field-label gform-field-label--type-inline'>Private service system <\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_133_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.5' type='checkbox'  value='Syst\u00e8mes l\u00e9gal et judiciaire'  id='choice_1_133_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_5' id='label_1_133_5' class='gform-field-label gform-field-label--type-inline'>Legal system<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_133_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.6' type='checkbox'  value='Gouvernement ou parti politique'  id='choice_1_133_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_6' id='label_1_133_6' class='gform-field-label gform-field-label--type-inline'>Political system, political parties or government<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_133_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.7' type='checkbox'  value='Forces arm\u00e9es canadiennes'  id='choice_1_133_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_7' id='label_1_133_7' class='gform-field-label gform-field-label--type-inline'>Canadian Armed Forces<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_133_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.8' type='checkbox'  value='Les services de police'  id='choice_1_133_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_8' id='label_1_133_8' class='gform-field-label gform-field-label--type-inline'>Police forces<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_133_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.9' type='checkbox'  value='M\u00e9dias de masse'  id='choice_1_133_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_9' id='label_1_133_9' class='gform-field-label gform-field-label--type-inline'>Mass Media<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_133_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.11' type='checkbox'  value='La section commentaire d&#039;une site web'  id='choice_1_133_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_11' id='label_1_133_11' class='gform-field-label gform-field-label--type-inline'>Comments section of a website<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_133_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.12' type='checkbox'  value='Les politiques et r\u00e8glements d&#039;une plateforme de m\u00e9dias sociaux'  id='choice_1_133_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_12' id='label_1_133_12' class='gform-field-label gform-field-label--type-inline'>Policy or regulation on social networks<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_133_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.13' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_133_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_13' id='label_1_133_13' class='gform-field-label gform-field-label--type-inline'>Other(s) (please specify below)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_133_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.14' type='checkbox'  value='Je ne sais pas'  id='choice_1_133_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_14' id='label_1_133_14' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_133_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_133.15' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_133_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_133_15' id='label_1_133_15' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><div class='mm_tooltip_text' style='display:none'><hr \/><p>FR : Par exemple, h\u00f4pitaux, CLSC, CHSLD, maisons de naissance, centres jeunesse, etc.) | EN : Hospitals, CLSC, child services, etc.<\/p><hr \/><p>FR : Par exemple, \u00e9coles primaires\/secondaires, c\u00e9geps, universit\u00e9s, etc. | EN : Elementary schools, high schools, cegeps, universities, etc.<\/p><hr \/><p>FR : Par exemple, biblioth\u00e8que municipale, piscine publique, etc. | EN : Public libraries, pools, municipal sports facilities, youth centres, etc.\u00a0<\/p><hr \/><p>FR : Par exemple, banques, entreprises | EN : Banks, businesses, etc.\u00a0<\/p><hr \/><p>FR : Par exemple, juges, notaires, avocats, etc. | EN : Courts, judges, lawyers, etc.<\/p><hr \/><hr \/><hr \/><hr \/><p>FR : Par exemple, journal, radio, t\u00e9l\u00e9vision, etc. | EN : Newspapers, radio, TV, etc.<\/p><hr \/><\/div><\/fieldset><div id=\"field_1_134\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_134'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_134' id='input_1_134' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_136' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_1_136' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_6' class='gform_page' data-js='page-field-id-136' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_139\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">6. DESCRIPTION<\/h3><\/div><div id=\"field_1_135\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Describe, in your own words, the violence or abuse you&#039;ve experienced. <\/h3><div class='gsection_description' id='gfield_description_1_135'>Please note that there are no restrictions or word limits and that you can upload an audio file in the language you prefer between English, French or Spanish<\/div><\/div><div id=\"field_1_137\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_137'>6V &#8211; Description<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_137' id='input_1_137' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_138\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_1_138'>Audio File<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_138' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_138&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_138&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_138&quot;,&quot;filelist&quot;:&quot;gform_preview_1_138&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/alix.interligne.co\\\/en\\\/?gf_page=ed246411945de4e&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/alix.interligne.co\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/alix.interligne.co\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;mp3&quot;}],&quot;max_file_size&quot;:&quot;10485760b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:138,&quot;_gform_file_upload_nonce_1_138&quot;:&quot;d80ef4f801&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;5&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_1_138&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_138' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_1_138' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_1_138\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_138'>Accepted file types: mp3, Max. file size: 10 MB, Max. files: 5.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_1_138'><\/ul> <div id='gform_preview_1_138' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_1_140\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">According to you, was this behaviour motivated by hatred or prejudices?*<\/h3><\/div><fieldset id=\"field_1_143\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >6V &#8211; Pr\u00e9jug\u00e9 ou haine<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_143'>\n\t\t\t<div class='gchoice gchoice_1_143_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_143' type='radio' value='Oui'  id='choice_1_143_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_143_0' id='label_1_143_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_143_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_143' type='radio' value='Non'  id='choice_1_143_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_143_1' id='label_1_143_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_142\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Yes<\/legend><div class='gfield_description' id='gfield_description_1_142'>You can select more than one option.<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_142'><div class='gchoice gchoice_1_142_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.1' type='checkbox'  value='Identit\u00e9 de genre'  id='choice_1_142_1'   aria-describedby=\"gfield_description_1_142\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_1' id='label_1_142_1' class='gform-field-label gform-field-label--type-inline'>Your actual or presumed gender identity<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.2' type='checkbox'  value='Orientation sexuelle'  id='choice_1_142_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_2' id='label_1_142_2' class='gform-field-label gform-field-label--type-inline'>Your actual or presumed sexual orientation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.3' type='checkbox'  value='Variation intersexe'  id='choice_1_142_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_3' id='label_1_142_3' class='gform-field-label gform-field-label--type-inline'>Your actual or presumed intersex variation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.4' type='checkbox'  value='Parcours trans'  id='choice_1_142_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_4' id='label_1_142_4' class='gform-field-label gform-field-label--type-inline'>Your actual or presumed trans journey<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.5' type='checkbox'  value='Parcours d\u00e9trans'  id='choice_1_142_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_5' id='label_1_142_5' class='gform-field-label gform-field-label--type-inline'>Detrans journey<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.6' type='checkbox'  value='Pratiques sexuelles'  id='choice_1_142_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_6' id='label_1_142_6' class='gform-field-label gform-field-label--type-inline'>Sexual practices<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.7' type='checkbox'  value='Appartenance ethnique'  id='choice_1_142_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_7' id='label_1_142_7' class='gform-field-label gform-field-label--type-inline'>Ethnicity<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.8' type='checkbox'  value='Appartenance raciale'  id='choice_1_142_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_8' id='label_1_142_8' class='gform-field-label gform-field-label--type-inline'>Racial affiliation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.9' type='checkbox'  value='Appartenance aux Premi\u00e8res nations, aux peuples Inuits et M\u00e9tis'  id='choice_1_142_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_9' id='label_1_142_9' class='gform-field-label gform-field-label--type-inline'>Being part of the First Nations, being Metis or Inuit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.11' type='checkbox'  value='Appartenance religieuse ou spirituelle'  id='choice_1_142_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_11' id='label_1_142_11' class='gform-field-label gform-field-label--type-inline'>Religious or spiritual affiliation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.12' type='checkbox'  value='Situation d\u2019itin\u00e9rance'  id='choice_1_142_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_12' id='label_1_142_12' class='gform-field-label gform-field-label--type-inline'>Homelessness situation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.13' type='checkbox'  value='Statut d\u2019immigration'  id='choice_1_142_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_13' id='label_1_142_13' class='gform-field-label gform-field-label--type-inline'>Immigration status<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.14' type='checkbox'  value='\u00c9tat civil'  id='choice_1_142_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_14' id='label_1_142_14' class='gform-field-label gform-field-label--type-inline'>Civil or relationship status<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.15' type='checkbox'  value='Statut parental'  id='choice_1_142_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_15' id='label_1_142_15' class='gform-field-label gform-field-label--type-inline'>Being a parent<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.16' type='checkbox'  value='Configuration relationnelle'  id='choice_1_142_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_16' id='label_1_142_16' class='gform-field-label gform-field-label--type-inline'>Relational configuration<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.17' type='checkbox'  value='\u00c9tat de sant\u00e9 mentale'  id='choice_1_142_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_17' id='label_1_142_17' class='gform-field-label gform-field-label--type-inline'>Mental health state<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.18' type='checkbox'  value='Appartenance \u00e0 la neurodivergence'  id='choice_1_142_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_18' id='label_1_142_18' class='gform-field-label gform-field-label--type-inline'>Neurotype<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.19' type='checkbox'  value='Maladie chronique'  id='choice_1_142_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_19' id='label_1_142_19' class='gform-field-label gform-field-label--type-inline'>Having a chronic illness<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.21' type='checkbox'  value='Langue'  id='choice_1_142_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_21' id='label_1_142_21' class='gform-field-label gform-field-label--type-inline'>Language<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.22' type='checkbox'  value='Degr\u00e9 de scolarit\u00e9'  id='choice_1_142_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_22' id='label_1_142_22' class='gform-field-label gform-field-label--type-inline'>Level of education<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.23' type='checkbox'  value='Occupation'  id='choice_1_142_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_23' id='label_1_142_23' class='gform-field-label gform-field-label--type-inline'>Occupation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.24' type='checkbox'  value='Pratique d\u2019une forme de travail du sexe'  id='choice_1_142_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_24' id='label_1_142_24' class='gform-field-label gform-field-label--type-inline'>Being or having been a sex worker<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.25' type='checkbox'  value='Revenu'  id='choice_1_142_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_25' id='label_1_142_25' class='gform-field-label gform-field-label--type-inline'>Income<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_26'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.26' type='checkbox'  value='Statut s\u00e9rologique'  id='choice_1_142_26'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_26' id='label_1_142_26' class='gform-field-label gform-field-label--type-inline'>HIV status<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_27'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.27' type='checkbox'  value='Situation de handicap'  id='choice_1_142_27'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_27' id='label_1_142_27' class='gform-field-label gform-field-label--type-inline'>Disability situation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_28'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.28' type='checkbox'  value='Condition de sant\u00e9'  id='choice_1_142_28'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_28' id='label_1_142_28' class='gform-field-label gform-field-label--type-inline'>Health condition<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_29'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.29' type='checkbox'  value='Statut judiciaire'  id='choice_1_142_29'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_29' id='label_1_142_29' class='gform-field-label gform-field-label--type-inline'>Judicial status<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_31'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.31' type='checkbox'  value='\u00c9tat d\u2019intoxication'  id='choice_1_142_31'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_31' id='label_1_142_31' class='gform-field-label gform-field-label--type-inline'>Intoxication level<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_32'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.32' type='checkbox'  value='Expression de genre'  id='choice_1_142_32'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_32' id='label_1_142_32' class='gform-field-label gform-field-label--type-inline'>Gender expression<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_33'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.33' type='checkbox'  value='Couleur de peau'  id='choice_1_142_33'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_33' id='label_1_142_33' class='gform-field-label gform-field-label--type-inline'>Skin color<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_34'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.34' type='checkbox'  value='Apparence physique'  id='choice_1_142_34'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_34' id='label_1_142_34' class='gform-field-label gform-field-label--type-inline'>Physical appearance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_35'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.35' type='checkbox'  value='\u00c2ge'  id='choice_1_142_35'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_35' id='label_1_142_35' class='gform-field-label gform-field-label--type-inline'>Age<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_36'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.36' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_142_36'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_36' id='label_1_142_36' class='gform-field-label gform-field-label--type-inline'>Other(s) (please specify below)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_37'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.37' type='checkbox'  value='Je ne sais pas'  id='choice_1_142_37'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_37' id='label_1_142_37' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_142_38'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_142.38' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_142_38'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_142_38' id='label_1_142_38' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_193\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_193'>Other(s)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_193' id='input_1_193' type='text' value='' class='large' maxlength='350'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1_146' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='button' id='gform_next_button_1_146' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1_7' class='gform_page' data-js='page-field-id-146' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_145\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">7. YOUR APPROACHES IN CONNECTION WITH THE VIOLENCE OR ABUSE <\/h3><\/div><div id=\"field_1_147\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">What are your needs in relation to the violence you&#039;ve experienced?*<\/h3><div class='gsection_description' id='gfield_description_1_147'>You can select more than one option.<\/div><\/div><fieldset id=\"field_1_148\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >7V &#8211; Besoins<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_148'><div class='gchoice gchoice_1_148_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.1' type='checkbox'  value='Besoin qu\u2019une personne m\u2019\u00e9coute'  id='choice_1_148_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_1' id='label_1_148_1' class='gform-field-label gform-field-label--type-inline'>Someone willing to listen to me<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.2' type='checkbox'  value='Besoin qu\u2019une personne me croie'  id='choice_1_148_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_2' id='label_1_148_2' class='gform-field-label gform-field-label--type-inline'>Someone to believe me<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.3' type='checkbox'  value='Besoin de pouvoir en parler en toute s\u00e9curit\u00e9'  id='choice_1_148_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_3' id='label_1_148_3' class='gform-field-label gform-field-label--type-inline'>A safe space to talk about it<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.4' type='checkbox'  value='Besoin d\u2019un suivi en relation d\u2019aide'  id='choice_1_148_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_4' id='label_1_148_4' class='gform-field-label gform-field-label--type-inline'>A follow-up with someone working in intervention<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.5' type='checkbox'  value='Besoin d\u2019un suivi en psychoth\u00e9rapie'  id='choice_1_148_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_5' id='label_1_148_5' class='gform-field-label gform-field-label--type-inline'>Psychotherapy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.6' type='checkbox'  value='Besoin d\u2019un suivi m\u00e9dical'  id='choice_1_148_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_6' id='label_1_148_6' class='gform-field-label gform-field-label--type-inline'>A medical follow-up<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.7' type='checkbox'  value='Besoin d\u2019entrer en contact avec d\u2019autres personnes ayant un v\u00e9cu similaire'  id='choice_1_148_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_7' id='label_1_148_7' class='gform-field-label gform-field-label--type-inline'>To be in touch with others with similar experiences<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.8' type='checkbox'  value='Besoin de conna\u00eetre les ressources disponibles'  id='choice_1_148_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_8' id='label_1_148_8' class='gform-field-label gform-field-label--type-inline'>To know what resources are available<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.9' type='checkbox'  value='Besoin d\u2019argent'  id='choice_1_148_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_9' id='label_1_148_9' class='gform-field-label gform-field-label--type-inline'>Money<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.11' type='checkbox'  value='Besoin d\u2019un endroit s\u00e9curitaire o\u00f9 me r\u00e9fugier'  id='choice_1_148_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_11' id='label_1_148_11' class='gform-field-label gform-field-label--type-inline'>A safe place to hide<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.12' type='checkbox'  value='Besoin d\u2019aide pour trouver un emploi'  id='choice_1_148_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_12' id='label_1_148_12' class='gform-field-label gform-field-label--type-inline'>Help to find a job<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.13' type='checkbox'  value='Besoin d\u2019aide pour trouver un logement'  id='choice_1_148_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_13' id='label_1_148_13' class='gform-field-label gform-field-label--type-inline'>Help to find a home<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.14' type='checkbox'  value='Legal help'  id='choice_1_148_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_14' id='label_1_148_14' class='gform-field-label gform-field-label--type-inline'>Legal help<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.15' type='checkbox'  value='Besoin d\u2019information sur mes droits et recours'  id='choice_1_148_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_15' id='label_1_148_15' class='gform-field-label gform-field-label--type-inline'>Informations about my rights and possible avenues<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.16' type='checkbox'  value='Besoin de faire une plainte'  id='choice_1_148_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_16' id='label_1_148_16' class='gform-field-label gform-field-label--type-inline'>To make a complaint<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.17' type='checkbox'  value='Besoin d\u2019accompagnement judiciaire'  id='choice_1_148_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_17' id='label_1_148_17' class='gform-field-label gform-field-label--type-inline'>Judicial support<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.18' type='checkbox'  value='Besoin de soutien ou d\u2019accompagnement pour faire un d\u00e9voilement'  id='choice_1_148_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_18' id='label_1_148_18' class='gform-field-label gform-field-label--type-inline'>Support or help to come out<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.19' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_148_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_19' id='label_1_148_19' class='gform-field-label gform-field-label--type-inline'>Other(s) (please specify below)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_148_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_148.21' type='checkbox'  value='Je n\u2019ai pas de besoin particulier en lien avec cette situation'  id='choice_1_148_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_148_21' id='label_1_148_21' class='gform-field-label gform-field-label--type-inline'>I don&#8217;t have any particular need related to this situation of violence<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_149\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_149'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_149' id='input_1_149' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_151\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Have you used services to meet these needs?*<\/h3><\/div><fieldset id=\"field_1_152\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >7V &#8211; Recours<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_152'>\n\t\t\t<div class='gchoice gchoice_1_152_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_152' type='radio' value='Oui'  id='choice_1_152_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_152_0' id='label_1_152_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_152_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_152' type='radio' value='Non'  id='choice_1_152_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_152_1' id='label_1_152_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_187\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Resources<\/h3><\/div><div id=\"field_1_177\" class=\"gfield gfield--type-form gfield--input-type-form gform-theme__no-reset--children gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_177'>To add a resource that you have used, click on &quot;Add Resource&quot; fill out the questions and then click on &quot;Add Resource&quot; again. You can do this for each resource you have used.<\/label><div class=\"gpnf-nested-entries-container ginput_container\">\n\n\t<table class=\"gpnf-nested-entries\">\n\n\t\t<thead>\n\t\t<tr>\n\t\t\t\t\t\t\t<th scope=\"col\" class=\"gpnf-field-1\">\n\t\t\t\t\tServices\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th scope=\"col\" class=\"gpnf-field-14\">\n\t\t\t\t\tType of ressources\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th scope=\"col\" class=\"gpnf-field-5\">\n\t\t\t\t\tHow satisfied\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th scope=\"col\" class=\"gpnf-field-13\">\n\t\t\t\t\tComments\t\t\t\t<\/th>\n\t\t\t\t\t\t<th scope=\"col\" class=\"gpnf-row-actions\"><span class=\"screen-reader-text\">Actions<\/span><\/th>\n\t\t<\/tr>\n\t\t<\/thead>\n\n\t\t<tbody data-bind=\"visible: entries().length, foreach: entries\">\n\t\t<tr data-bind=\"attr: { 'data-entryid': id }\">\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f1.label, attr: { 'data-value': f1.label }\"\n\t\t\t\t\tdata-heading=\"Services\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f14.label, attr: { 'data-value': f14.label }\"\n\t\t\t\t\tdata-heading=\"Type of ressources\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f5.label, attr: { 'data-value': f5.label }\"\n\t\t\t\t\tdata-heading=\"How satisfied\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f13.label, attr: { 'data-value': f13.label }\"\n\t\t\t\t\tdata-heading=\"Comments\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t<td class=\"gpnf-row-actions\" style=\"display: none;\" data-bind=\"visible: true\">\n\t\t\t\t<ul>\n\t\t\t\t\t<li class=\"edit\"><button type=\"button\" class=\"edit-button gform-theme-button--secondary\" data-bind=\"click: $parent.editEntry, attr: { 'aria-label': 'Edit Resource {0} where Services is {1}.'.gformFormat( $index() + 1, f1.label ) }\">Edit<\/button><\/li>\n\t\t\t\t\t\t\t\t\t\t<li class=\"delete\"><button type=\"button\" class=\"delete-button gform-theme-button--simple gform-theme-button--size-md\" data-bind=\"click: $parent.deleteEntry, attr: { 'aria-label': 'Delete Resource {0} where Services is {1}.'.gformFormat( $index() + 1, f1.label ) }\">Delete<\/button><\/li>\n\t\t\t\t<\/ul>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t<\/tbody>\n\n\t\t<tbody data-bind=\"visible: entries().length <= 0\">\n\t\t<tr class=\"gpnf-no-entries\" data-bind=\"visible: entries().length <= 0\" style=\"display: none;\">\n\t\t\t<td colspan=\"5\">\n\t\t\t\tThere are no <span>Resources.<\/span>\t\t\t<\/td>\n\t\t<\/tr>\n\t\t<\/tbody>\n\n\t<\/table>\n\n\t<button type=\"button\" class=\"gpnf-add-entry\"\n\t\t        data-formid=\"1\"\n\t\t        data-nestedformid=\"3\"\n\t\t\t\tdata-bind=\"attr: { disabled: isMaxed }, css: { 'gf-default-disabled': isMaxed }\"\n\t\t\t\t>\n\t\t\t\tAdd Resource\n\t\t\t<\/button>\t\n\t\t\t<p class=\"gpnf-add-entry-max\" data-bind=\"visible: isMaxed\" style=\"display: none;\">\n\t\t\t\tMaximum number of resources reached.\n\t\t\t<\/p>\n<\/div>\n<input type=\"hidden\"\n                name=\"input_177\"\n                id=\"input_1_177\"\n                data-bind=\"value: entryIds\"\n                value=\"\" \/><\/div><div id=\"field_1_161\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">What are the difficulties that you have encountered in your efforts?<\/h3><\/div><fieldset id=\"field_1_160\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >7V &#8211; Difficult\u00e9s<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_160'><div class='gchoice gchoice_1_160_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.1' type='checkbox'  value='Crainte de devoir faire un coming out'  id='choice_1_160_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_1' id='label_1_160_1' class='gform-field-label gform-field-label--type-inline'>Fear of having to come out<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.2' type='checkbox'  value='Crainte de repr\u00e9sailles'  id='choice_1_160_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_2' id='label_1_160_2' class='gform-field-label gform-field-label--type-inline'>Fear of repercussions or reprisal<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.3' type='checkbox'  value='Crainte qu\u2019une personne ne te croie pas'  id='choice_1_160_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_3' id='label_1_160_3' class='gform-field-label gform-field-label--type-inline'>Fear that you will not be believed<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.4' type='checkbox'  value='Crainte que le service soit inadapt\u00e9 ou inad\u00e9quat'  id='choice_1_160_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_4' id='label_1_160_4' class='gform-field-label gform-field-label--type-inline'>Fear that the service is not suitable or adequate<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.5' type='checkbox'  value='Crainte qu\u2019une personne te reconnaisse'  id='choice_1_160_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_5' id='label_1_160_5' class='gform-field-label gform-field-label--type-inline'>Fear that you will be recognized<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.6' type='checkbox'  value='Crainte de croiser quelqu&#039;un que tu connais dans le service'  id='choice_1_160_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_6' id='label_1_160_6' class='gform-field-label gform-field-label--type-inline'>Fear of crossing a known person in the service<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.7' type='checkbox'  value='Crainte de recevoir du jugement'  id='choice_1_160_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_7' id='label_1_160_7' class='gform-field-label gform-field-label--type-inline'>Fear of receiving judgment or being prejudices<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.8' type='checkbox'  value='Manque de temps'  id='choice_1_160_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_8' id='label_1_160_8' class='gform-field-label gform-field-label--type-inline'>Lack of time<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.9' type='checkbox'  value='Manque de ressources financi\u00e8res'  id='choice_1_160_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_9' id='label_1_160_9' class='gform-field-label gform-field-label--type-inline'>Lack of money<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.11' type='checkbox'  value='Manque d\u2019int\u00e9r\u00eat'  id='choice_1_160_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_11' id='label_1_160_11' class='gform-field-label gform-field-label--type-inline'>Lack of interest<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.12' type='checkbox'  value='Liste d\u2019attente'  id='choice_1_160_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_12' id='label_1_160_12' class='gform-field-label gform-field-label--type-inline'>Waiting lists<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.13' type='checkbox'  value='Complexit\u00e9 du processus judiciaire'  id='choice_1_160_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_13' id='label_1_160_13' class='gform-field-label gform-field-label--type-inline'>Long and complicated court and judicial processes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.14' type='checkbox'  value='Ignorance des ressources disponibles'  id='choice_1_160_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_14' id='label_1_160_14' class='gform-field-label gform-field-label--type-inline'>Not knowing the appropriate resources<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.15' type='checkbox'  value='Ignorance de tes droits et recours'  id='choice_1_160_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_15' id='label_1_160_15' class='gform-field-label gform-field-label--type-inline'>Not knowing my rights<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.16' type='checkbox'  value='Inaccessibilit\u00e9 aux ressources d\u00e9sir\u00e9es (pr\u00e9ciser les raisons)'  id='choice_1_160_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_16' id='label_1_160_16' class='gform-field-label gform-field-label--type-inline'>Not having access to the desired resources (Please specify what makes you unable to access the desired resources below)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.17' type='checkbox'  value='Mauvaise exp\u00e9rience avec un service d\u2019aide'  id='choice_1_160_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_17' id='label_1_160_17' class='gform-field-label gform-field-label--type-inline'>Bad experience with a help service<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.18' type='checkbox'  value='Refus de la part d\u2019un service d\u2019aide'  id='choice_1_160_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_18' id='label_1_160_18' class='gform-field-label gform-field-label--type-inline'>Refusal from a help service<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.19' type='checkbox'  value='Repr\u00e9sailles'  id='choice_1_160_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_19' id='label_1_160_19' class='gform-field-label gform-field-label--type-inline'>Having been retaliated in the past<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.21' type='checkbox'  value='Langue de prestation des services (Pr\u00e9cise la langue dans laquelle tu d\u00e9sirerais recevoir des services)'  id='choice_1_160_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_21' id='label_1_160_21' class='gform-field-label gform-field-label--type-inline'>The language of the services offered (Please specify the language in which you would like to receive services below)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.22' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_160_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_22' id='label_1_160_22' class='gform-field-label gform-field-label--type-inline'>Other(s) (please specify below)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.23' type='checkbox'  value='Je ne sais pas'  id='choice_1_160_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_23' id='label_1_160_23' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_160_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_160.24' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_160_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_160_24' id='label_1_160_24' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_162\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_162'>Not having access to the desired resources<\/label><div class='ginput_container ginput_container_text'><input name='input_162' id='input_1_162' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_188\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_188'>Preferred language<\/label><div class='ginput_container ginput_container_text'><input name='input_188' id='input_1_188' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_163\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_163'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_163' id='input_1_163' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_165\" class=\"gfield gfield--type-section gfield--input-type-section gsection alix-color field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Why didn\u2019t you seek any services? <\/h3><\/div><fieldset id=\"field_1_164\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >7V &#8211; Sans recours<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_164'><div class='gchoice gchoice_1_164_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.1' type='checkbox'  value='Crainte de devoir faire un coming out'  id='choice_1_164_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_1' id='label_1_164_1' class='gform-field-label gform-field-label--type-inline'>Fear of having to come out<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.2' type='checkbox'  value='Crainte des repr\u00e9sailles'  id='choice_1_164_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_2' id='label_1_164_2' class='gform-field-label gform-field-label--type-inline'>Fear of repercussion or reprisal<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.3' type='checkbox'  value='Crainte qu\u2019une personne ne te croie pas'  id='choice_1_164_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_3' id='label_1_164_3' class='gform-field-label gform-field-label--type-inline'>Fear that you will not be believed<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.4' type='checkbox'  value='Crainte que le service soit inadapt\u00e9 ou inad\u00e9quat'  id='choice_1_164_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_4' id='label_1_164_4' class='gform-field-label gform-field-label--type-inline'>Fear that the service is not suitable or adequate<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.5' type='checkbox'  value='Crainte qu\u2019une personne te reconnaisse'  id='choice_1_164_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_5' id='label_1_164_5' class='gform-field-label gform-field-label--type-inline'>Fear that you will be recognized<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.6' type='checkbox'  value='Crainte de croiser une personne que tu connais dans le service'  id='choice_1_164_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_6' id='label_1_164_6' class='gform-field-label gform-field-label--type-inline'>Fear of crossing a known person in the service<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.7' type='checkbox'  value='Crainte de recevoir du jugement'  id='choice_1_164_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_7' id='label_1_164_7' class='gform-field-label gform-field-label--type-inline'>Fear of receiving judgment or being prejudices<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.8' type='checkbox'  value='Manque de temps'  id='choice_1_164_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_8' id='label_1_164_8' class='gform-field-label gform-field-label--type-inline'>Lack of time<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.9' type='checkbox'  value='Manque de ressources financi\u00e8res'  id='choice_1_164_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_9' id='label_1_164_9' class='gform-field-label gform-field-label--type-inline'>Lack of money<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.11' type='checkbox'  value='Manque de force'  id='choice_1_164_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_11' id='label_1_164_11' class='gform-field-label gform-field-label--type-inline'>Lack of strength\/energy<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.12' type='checkbox'  value='Liste d\u2019attente'  id='choice_1_164_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_12' id='label_1_164_12' class='gform-field-label gform-field-label--type-inline'>Waiting lists<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.13' type='checkbox'  value='Complexit\u00e9 du processus judiciaire'  id='choice_1_164_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_13' id='label_1_164_13' class='gform-field-label gform-field-label--type-inline'>Long and complicated court and judicial processes<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.14' type='checkbox'  value='Ignorance des ressources disponibles'  id='choice_1_164_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_14' id='label_1_164_14' class='gform-field-label gform-field-label--type-inline'>Ignorance des ressources disponibles<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_15'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.15' type='checkbox'  value='Inaccessibilit\u00e9 aux ressources d\u00e9sir\u00e9es (pr\u00e9ciser les raisons)'  id='choice_1_164_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_15' id='label_1_164_15' class='gform-field-label gform-field-label--type-inline'>Not having access to the desired resources (Please specify what makes you unable to access the desired resources below)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_16'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.16' type='checkbox'  value='Ignorance de tes droits et recours'  id='choice_1_164_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_16' id='label_1_164_16' class='gform-field-label gform-field-label--type-inline'>Not knowing my rights<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_17'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.17' type='checkbox'  value='Mauvaise exp\u00e9rience pass\u00e9e avec un service d\u2019aide'  id='choice_1_164_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_17' id='label_1_164_17' class='gform-field-label gform-field-label--type-inline'>Bad experience in the past with a help service<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_18'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.18' type='checkbox'  value='Refus pass\u00e9 de la part d\u2019un service d\u2019aide'  id='choice_1_164_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_18' id='label_1_164_18' class='gform-field-label gform-field-label--type-inline'>Past refusal from a help service<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_19'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.19' type='checkbox'  value='Exp\u00e9rience de repr\u00e9sailles'  id='choice_1_164_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_19' id='label_1_164_19' class='gform-field-label gform-field-label--type-inline'>Having been retaliated in the past<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_21'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.21' type='checkbox'  value='Langue de prestation des services (Pr\u00e9cise la langue dans laquelle tu d\u00e9sirerais recevoir ces services)'  id='choice_1_164_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_21' id='label_1_164_21' class='gform-field-label gform-field-label--type-inline'>The language of the services offered (Please specify the language in which you would like to receive the services below)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_22'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.22' type='checkbox'  value='Absence du besoin de le faire'  id='choice_1_164_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_22' id='label_1_164_22' class='gform-field-label gform-field-label--type-inline'>I did not feel the need to<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_23'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.23' type='checkbox'  value='Autre(s) (pr\u00e9ciser)'  id='choice_1_164_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_23' id='label_1_164_23' class='gform-field-label gform-field-label--type-inline'>Other(s) (please specify below)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_24'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.24' type='checkbox'  value='Je ne sais pas'  id='choice_1_164_24'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_24' id='label_1_164_24' class='gform-field-label gform-field-label--type-inline'>I do not know<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_164_25'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_164.25' type='checkbox'  value='Je pr\u00e9f\u00e8re ne pas r\u00e9pondre'  id='choice_1_164_25'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_164_25' id='label_1_164_25' class='gform-field-label gform-field-label--type-inline'>I prefer not to answer<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_166\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_166'>Not having access to the desired resources<\/label><div class='ginput_container ginput_container_text'><input name='input_166' id='input_1_166' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_189\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_189'>Preferred language<\/label><div class='ginput_container ginput_container_text'><input name='input_189' id='input_1_189' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_167\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_167'>Other(s)<\/label><div class='ginput_container ginput_container_text'><input name='input_167' id='input_1_167' type='text' value='' class='large' maxlength='350'     aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_192\" class=\"gfield gfield--type-captcha gfield--input-type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_192'>CAPTCHA<\/label><div id='input_1_192' class='ginput_container ginput_recaptcha' data-sitekey='6Lf7CCccAAAAAJoQsJX947npbMFFy3ucafKyx8vA'  data-theme='light' data-tabindex='-1' data-size='invisible' data-badge='bottomright'><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_1' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Back'  \/> <input type='submit' id='gform_submit_button_1' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Send'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1' id='gform_theme_1' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1' id='gform_style_settings_1' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='+aC2MuFScC21rY5JtFawWQPK9zCO3cqRBRzZX61QGYXf1mF\/akH20RLgBDilPP9vbyLp5vvlTIxJAXrbPxJZWWI\/ebmTPaq5aaWS3asFn+J2pWw=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1' value='WyJbXSIsImI3ODkyNjVhNzAxZmEyZTM1ZmIwYmEyOGY2NDE3ZTI2Il0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_1' id='gform_target_page_number_1' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_1' id='gform_source_page_number_1' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_1' value='' \/>\n        <\/div>\n             <\/div><\/div>\n                        <\/form>\n                        <\/div><script>\ngform.initializeOnLoaded( function() {gformInitSpinner( 1, 'https:\/\/alix.interligne.co\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_1').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_1');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_1').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_1').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_1').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_1').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_1').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_1').val();gformInitSpinner( 1, 'https:\/\/alix.interligne.co\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [1, current_page]);window['gf_submitting_1'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_1').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_1').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [1]);window['gf_submitting_1'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_1').text());}else{jQuery('#gform_1').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"1\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_1\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_1\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_1\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 1, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} );\n<\/script>\n\n\n<!--noptimize--><script type=\"text\/javascript\">\r\n    var captainformCustomVars = {};\r\n    var captainformThemeStyle = {};\r\n    var append_element = append_element || function(e){if(void 0==e)return!1;if(!(\"elementType\"in e))return!1;var n=null;if(n=e.following?e.following.parentElement:e.inside?e.inside:e.replacing?e.replacing.parentElement:\"script\"==e.elementType?document.head:document.body,null==n)return!1;var l=document.createElement(e.elementType);delete e.elementType,l=jQuery.extend(l,e),e.replacing?n.replaceChild(l,e.replacing):n.appendChild(l)};\r\n    var captainformDomReady = captainformDomReady || function(e){var t=!1,n=function(){document.addEventListener?(document.removeEventListener(\"DOMContentLoaded\",d),window.removeEventListener(\"load\",d)):(document.detachEvent(\"onreadystatechange\",d),window.detachEvent(\"onload\",d))},d=function(){t||!document.addEventListener&&\"load\"!==event.type&&\"complete\"!==document.readyState||(t=!0,n(),e())};if(\"complete\"===document.readyState)e();else if(document.addEventListener)document.addEventListener(\"DOMContentLoaded\",d),window.addEventListener(\"load\",d);else{document.attachEvent(\"onreadystatechange\",d),window.attachEvent(\"onload\",d);var o=!1;try{o=null==window.frameElement&&document.documentElement}catch(a){}o&&o.doScroll&&!function c(){if(!t){try{o.doScroll(\"left\")}catch(d){return setTimeout(c,50)}t=!0,n(),e()}}()}};\r\n    var readyStateOverflowInterval;\r\n    captainformDomReady(function() {\r\n        if (document.getElementById('captainform_js_global_vars') == null) {\r\n            append_element({\r\n                elementType: \"script\",\r\n                type: \"text\/javascript\",\r\n                id: \"captainform_js_global_vars\",\r\n                textContent: 'var frmRef=\"\"; try { frmRef=window.top.location.href; } catch(err) {}; var captainform_servicedomain=\"app.captainform.com\";var cfJsHost = \"https:\/\/\";',\r\n            });\r\n        }\r\n            });\r\n<\/script><!--\/noptimize--><!--noptimize--><script type=\"text\/javascript\">\r\n    captainForm1277338PreloadInterval69dcb15fa8ece = setInterval(function(){\r\n        if(typeof cfJsHost != 'undefined'){\r\n            captainformCustomVars['1277338'] = '';\r\n            captainformThemeStyle['1277338'] = '';\r\n            var popupParams = {\r\n                formId: '1277338'\r\n            };\r\n            captainform_preload_form_popup(popupParams);\r\n            clearInterval(captainForm1277338PreloadInterval69dcb15fa8ece);\r\n            var popupTrigger = jQuery(\"#captainformForm1277338EmbedPopup69dcb15fa8ece\");\r\n            popupTrigger.css('visibility', 'visible');\r\n            popupTrigger.click(function(){\r\n                captainform_create_form_popup(popupParams);\r\n            });\r\n        }\r\n    }, 10);\r\n<\/script><!--\/noptimize--><span floating id='captainformForm1277338EmbedPopup69dcb15fa8ece' class=\"captainform_lightbox bottom\" style=\"visibility:hidden; background-color: #1abc9c;\"><span id='captainformForm1277338EmbedPopupContent69dcb15fa8ece' class=\"floating-button-content\"><a style=\"color:#FFFFFF\" href=\"javascript:\">Laissez-nous un commentaire<\/a><\/span><\/span><!--noptimize--><script type=\"text\/javascript\">\r\n    function resize127733869dcb15fa8ece(wrapper){\r\n        if ('bottom' == 'left')\r\n            jQuery(wrapper).css('top', jQuery(window).height() * 0.4 + wrapper.width() + wrapper.css('padding').replace('px', '') * 2);\r\n        else if ('bottom' == 'right')\r\n            jQuery(wrapper).css('top', jQuery(window).height() * 0.4 - wrapper.outerHeight());\r\n    }\r\n    if('floating' == 'floating') {\r\n        setTimeout(function () {\r\n            var wrapper = jQuery('#captainformForm1277338EmbedPopup69dcb15fa8ece');\r\n            resize127733869dcb15fa8ece(wrapper);\r\n            jQuery(wrapper).find('a').removeAttr('href');\r\n        }, 50);\r\n    }\r\n    window.addEventListener('resize', function(){\r\n        var wrapper = jQuery('#captainformForm1277338EmbedPopup69dcb15fa8ece');\r\n        resize127733869dcb15fa8ece(wrapper);\r\n    }, true);\r\n<\/script><!--\/noptimize-->\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_uag_custom_page_level_css":"","footnotes":""},"class_list":["post-2981","page","type-page","status-publish"],"uagb_featured_image_src":{"full":false,"thumbnail":false,"medium":false,"medium_large":false,"large":false,"1536x1536":false,"2048x2048":false,"gform-image-choice-sm":false,"gform-image-choice-md":false,"gform-image-choice-lg":false},"uagb_author_info":{"display_name":"Support","author_link":"https:\/\/alix.interligne.co\/en\/author\/support\/"},"uagb_comment_info":0,"uagb_excerpt":null,"_links":{"self":[{"href":"https:\/\/alix.interligne.co\/en\/wp-json\/wp\/v2\/pages\/2981","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/alix.interligne.co\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/alix.interligne.co\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/alix.interligne.co\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/alix.interligne.co\/en\/wp-json\/wp\/v2\/comments?post=2981"}],"version-history":[{"count":4,"href":"https:\/\/alix.interligne.co\/en\/wp-json\/wp\/v2\/pages\/2981\/revisions"}],"predecessor-version":[{"id":3212,"href":"https:\/\/alix.interligne.co\/en\/wp-json\/wp\/v2\/pages\/2981\/revisions\/3212"}],"wp:attachment":[{"href":"https:\/\/alix.interligne.co\/en\/wp-json\/wp\/v2\/media?parent=2981"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}