Membership Renewal Form

Membership Renewal Form
Personal information

banniere

Member Number:

Date:

Association des descendants de

Noël Legault dit Deslauriers inc.

Secretary: Nancy Legault

378, St-Georges,

Ste-Marie-de-Beauce (Québec) G6E2P1,

Email:
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 address:

@
Profession:

Annual 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 ou US)           

Please make your cheque payable to “ADNLD inc.”

Fill in the form directly at the screen,

and press “print”,

then sign andaddress to:

Mrs. Réjeanne Desjardins

Treasurer, ADNLD inc.

396 Saint-Laurent Street

Saint-Eustache (Québec) J7P 1R6

Signature:

F-2010-5 renewal (Rev 2011) ADNLD inc.