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To become a member of the Association
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| Print this form, fill it out and send with your payment (cash, cheque or money order) to the address indicated below. Make the cheque or money order payable to the "Association des Boudreau Inc." A membership card will be sent to you soon after we've received your order. |
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Personal Information:
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Name |
Surname |
Birth Date (D/M/Y) |
| Member |
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| Spouse |
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| Address: |
St. (Apt.) |
P.O. Box |
Site |
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Town/City , Province/State |
Postal/Zip Code |
| Telephone: |
Residence
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Office |
E-mail |
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Children: Only register those children still living at home
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Birth Date (D/M/Y) |
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Registration Fee
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| Single |
$10.00 Cdn |
$10.00 US |
| Family |
$15.00 Cdn |
$15.00 US |
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Amount:
Date: __________________
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| Send to address: |
Association des Boudreau Inc.
131 Fourth Ave.
Pointe-du-Chêne N.B.
Canada
E4P 4H5 |
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