AFB inc. - Application form

Association des familles Bérubé inc.
C.P. 10090, Succ. Ste-Foy, Québec (QC)Canada G1V 4C6

With Faith
Courage
Wisdom

APPLICATION FORM
new member [ __ ] or renewal [ __ ] member no : ____________

MEMBER	Spouse or Partner
Name	Name
Surname	Surname
Birthday : Year/Month/Day

Personal information

Address		Apt.
City	Prov./St.	Zip Code
Email	Phone #

Procedure

Print this page, fill it out, and send it to the address mentioned above.
Make the check or the money order in the name of Association des familles Bérubé inc.

Membership fees

Membership	Canada	United States	Europe
Membership (subscriber) per year	25 $	$25	25 €
Seven-year membership (member for at least 2 years)	125 $	$125	125 €
Life membership (member for at least 5 years and older than 50 years)	250 $	$250	250 €
SIGNATURE	DATE

Back
AFB inc. 01-révisé 2009/10/15

Association des familles Bérubé inc. C.P. 10090, Succ. Ste-Foy, Québec (QC)Canada G1V 4C6

Association des familles Bérubé inc.
C.P. 10090, Succ. Ste-Foy, Québec (QC)Canada G1V 4C6