APPLICATION FOR MEMBERSHIP

Written by Administrator | 11 June 2010

After filling in all boxes, send this form by clicking SUBMIT. Then print, sign and send it with your cheque

for a twelve months subscription to ASSOCIATION DES DESCENDANTS DES LEMIEUX D'AMÉRIQUE

322 Ch. des Chalets Coaticook J1A 2S4 Coaticook Canada .

Upon receipt of your membership card by mail, you may request the password to access the Members Section via Email

Please enter information or comments (i.e. Unknown, N/A etc...)
Name and surname:
E-mail address:
Address (street or POBox):
City or town:
Zip code
Telephone:
Date and place of birth:
Name of spouse:
Date and place of birth:
Date and place of marriage:
Marriage or living common law:
Name of your father:
Name of your mother:
Date and place of their marriage:
Name of your grandfather:
Name of your grandmother:
Date and place of their marriage:
Notes:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DECLARATION

Yes___No___  I accept that my name and email, showed on the member list, be distributed to members asking for it.
Yes___No___  I accept that my name and other informations  be used in genealogical publications of the Association.


I hereby apply for membership and I enclose my cheque made to Descendant Lemieux in the amount  of $20.00 (single) or $30.00 (couple) for twelve months.

 

Signature........................................................................... Date.................................................................