SUBSCRIPTION FORM

 

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Name :
Birth place :
Date of birth :
Father's name :
Maiden name of mother :
Husband name :
Wedding place :
Wedding Date :
Children under 18 years of age : Oui Non
If yes, how many ? 1 2 3 4
Name of 1st child :
Name of 2d child :
Name of 3rd child :
Name of 4th child :
Adress :
City :
Province :
Postal code :
Telephon number :
Email address :
Type of membership :

yearly (25 $) 8 years (180 $) life (400 $)

yearly (30 $) 8 years (220 $) life (500 $)

yearly (35 $) 8 years (250 $) life (600 $)

For the Canada 25 $ / yearly 180 $ / 8 years, 400 $ / life.
For the U.S.A. 30 $ / yearly, 220 $ / 8 years, 500 $ / life.
For the Europe 35 $ / yearly, 250 $ / 8 years, 600 $ / life.

 

Included is a cheque in the amount of ______$ made to

the Faucher and Foucher's Association (Châteauvert, Saint-Maurice).
* Membership cover also the wife and all children under 18 years of age.

Signature : ________________________________________

Print this form and send it to the following adress :
(don't forget to include your payment)

Faucher and Foucher's Association (Châteauvert, Saint-Maurice).

SS-09-650, street Graham-Bell
Québec QC G1N 4H5 

Brochure to the Association des Faucher et Foucher ( Châteauvert, Saint-Maurice)

Membership application form