To become a member of the AFG, you simply have to :  PRINT,   COMPLETE  and  MAIL  (with your subscription) the following Membership Form to:

c/o   Association des Familles Gareau Inc  -  619 de Verrazano, Boucherville  - Québec, Canada, J4B  7P9

MEMBERSHIP   FORM

I wish to contribute to the preservation of the Gareau patrimonial through my membership to the

Association des Familles Gareau Inc

619 de Verrazzano Boucherville, Québec, Canada, J4B 7P9

As  a:  Regular Member ( adhesion $6.00 + annual membership $35.00 )

        My spouse would like to become a Spousal Member. ADD $5.00

1- YOUR  NAME                                                                                                                               

2- ADDRESS                                                                                                                                      

3- TELEPHONE                                                            FAX                                                         

4- EMAIL                                                                                      

5- YOUR DATE and PLACE of BIRTH                                                                                             

6 - OCCUPATION                                                                                                                            

7 - Name of your father                                                                                                                       

         Date and Place of birth                                                                                                                

8 - Name of your mother                                                                                                                      

         Date and Place of birth                                                                                                                

9 - NAME of your SPOUSE                                                                                                               

         Date and Place of birth                                                                                                             

Please complete for the following autorisations :

"I, the undersigned, 

                  A) agree (  ), refuse (  ) to have my address be published

                  B) agree (  ), refuse (  ) to have my phone number be published

                  C) agree (  ), refuse (  ) to have my address be published

D) agree (  ), refuse (  ) that any information or document provided to the A.F.G.

     published in a dictionary or any other publication."

These authorisations can be revoked at any time.

SIGNATURE                                                                                DATE                                           

Please send us your photo for our files

or a family photo, clearly identifying each person included in it