I would like to join the
           Association des familles Bélanger, inc.
 

                  Please, write a cheque in the amount of 25.00$ in Canada
(30.00 in USA fund for the people living outside Canada (Europe 30.00 Euros)

Please, PRINT this page
        and send it to us. Filled form and cheque included
   to the following address:
 
                      Nicole H. Bélanger
                                            Secretary

                                              C.P. 55033 Succ. Montmorency
                                          Laval, H7N 5G6
                                      Canada
 
 
 

Family name________________________________

Given name_______________________________

Adress____________________________________________________

City__________________________________ Prov./State_____________

Postal Code_________________ Tel.:    (       )______________________

e-Mail:______________________________________

Signature:_____________________________________

To obtain information concerning our Association,                                                                          
Click       HERE