(Dufour families association of America)
DUFOUR
ASSOCIATION DES FAMILLES DUFOUR D’AMÉRIQUE Inc.
MEMBERSHIP or RENEWAL FORM
MEMBERSHIP: HOW TO BECOME A MEMBER? 1. Print, 2. Complete 3. and send this form with your
check
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M.
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Birth date: |
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New
member : yes ( ) no
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Member number if known:: |
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ADDRESS in block letters:
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Number : |
Appartment. : |
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City : |
Prov. /State : |
Country : |
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Postal Code or ZIP : |
Phone # : Other phone #: |
Cell phone # : Other cell phone#: |
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Email: |
Other email: |
Description of your family branch « DUFOUR »
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Your father first and last name : |
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Your mother first and last name : |
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Your grandfather first and last name : |
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Yourgrandmother first and last name : |
INSTRUCTIONS
AND FEES
Cost
- > check : ( ) 15 $ (1) year;
( ) 25 $ (2) years; (
) 50 $ (5) years; ( )
150 $ lifetime member (best value)
Make out your check to the attention of " Association des Familles Dufour d’Amérique Inc."
Send by mail to : Association des Familles Dufour d’Amérique Inc.
211, Du Ruisseau Nicolet, Qc
J3T 0B7
Attn. : Lise St-Jean
SIGN here : _____________________________________Date of signature:_____________________
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Reserved
to the administration |
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Numéro du chèque : |
Montant $ : |
Date du chèque : |
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Date de réception : |
de l’échéance : |
du renouvellement : |
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Nom de la lignée concernée : |
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NOTE : Please feel free to make copies of this form and to distribute to any potential member ! |
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