Surname: ..........................................................First Name:............................................

Street: ................................................................................ Apt. or P.O. Box: ...............

City: .................................................................................... State-Province : .................

Country: ................. Zip-Postal Code: ................. Telephone : (.........) ..........-................

E-mail: ............................................................................................................

Signature: .........................................................................Date:.........................................

GENEALOGICAL INFORMATION

Civil status: ..................... Trade or profession: .................. Retired: .................

Date and place of birth:........................................................................................................
My father's name: ................................................................................................................
My mother's maiden name: ..................................................................................................
Date and place of their marriage : .........................................................................................
My brothers : ......................................................................................................................
My sisters : .........................................................................................................................

Spouse's (maiden) name: .....................................................................................................
Date and place of our marriage : ..........................................................................................
Our children: .......................................................................................................................
Spouse father's name: ..........................................................................................................
Spouse mother's name: ........................................................................................................

My MICHAUD grandfather's name : ...................................................................................
My grandmother's maiden name: ..........................................................................................
Date and place of their marriage: ..........................................................................................

My MICHAUD great-grandfather's name: ...........................................................................
My great-grandmother's maiden name: .................................................................................
Date and place of their marriage: ..........................................................................................

Comments : .........................................................................................................................
............................................................................................................................................
............................................................................................................................................

Return your form to:	Association des Familles Michaud inc.
	P.O. Box 45,
	Rimouski, QC Canada
	G5L 7B7

Correspondence in ................English ..................French