Membership Application Form

Membership Application Form
Personal Information banniere
Membership:

Date:

Association des descendants de

Noël Legault dit Deslauriers inc.

Secretary: Mrs. Nancy Legault

378 av. St-Georges,

 Ste-Marie-de-Beauce (Quebec),

G6E 2P1


nanlegault@gmail.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it

Website: http://www.legault-deslauriers.ca

Surname:

First Name:

Address:

City:

Province or State:

Postal Code:

Telephone:    (res.):

Telephone:  (other):

Email:

@

Profession:

 

Membership Fee

(Valid: April 1st till March 31st)

Membership        ($25 CAD)                                 $25.00

Membership        ($35 US)                                   $35.00

Donation to help the Association (optional

TOTAL     (CAD or US)        

 

Please denominate your check in the order of ” ADNLD inc.

You have only to fill the form directly in the screen and to press on the button “To print“,

then sign and address the form to:
Mrs. Réjeanne Desjardins

Treasurer, ADNLD inc.
396 Saint-Laurent Street

Saint-Eustache (Québec) J7P 1R6

The Association Welcomes You!

Signature:

Family Registration

(If, you do not wish your information to be made available online, please check this box:
Member (Yourself)

Date of Birth:

City:

Date of Baptism:

Parish:

Your father

Surname:

First Name:

Your mother

Maiden Name:

First Name:

Religious life community

Religious Community:

Date Entered:

City:

Your Mariage

Date:

Place (parish or other):

City:

Spouse

Surname:

First Name:

Date of Birth:

City:

Date of Baptism:

Parish:

Father

Surname:

First Name:

Mother

Maiden Name:

First Name:

First child
Sex: Male Female
Surname: First Name:
Date of Birth: City:
Date of Baptism: Parish:
Married: Yes No
Spouse
Surname: First Name:
Second child
Sex: Male Female
Surname: First Name:
Date of Birth: City:
Date of Baptism: Parish:
Married: Yes No
Spouse
Surname: First Name:
Third child
Sex: Male Female
Surname: First Name:
Date of Birth: City:
Date of Baptism: Parish:
Married: Yes No
Spouse
Surname: First Name:

The configuration of your printer will influence the result of printing. It is strongly recommended to remove any configuration on the layout under the section “Fichier” “Layout” of your browser (Internet Explorer either Mozilla FireFox or the others) and to remove margins, footer and top of page for a better result.

F-2010-7 application (Rev 2011) ADNLD inc.