
Membership Application to
Association des Familles Messier inc.
Membership Renewal
Name: __
First name:
Member no:
Signature:
Date:
Enclosed: 15 $ One year regular membership
50 $ One year benefactor membership
200 $ Life membership
Send completed application with your check made to:
Association des Familles Messier Inc.
c/o Réjean Messier
1621 St.Gérard
St. Alexandre, QC
J0J 1S0
Tel : 450 346-2976
New membership Application
Name:
First name:
Address:
City: State: Postal code:
Telephone number:
Email:
I authorize Association des Familles Messier to publish my email address:
Yes______ No _______
Date of birth:
Place of birth:
Occupation:
Civil status: S___M___W___D___Other_________
Spouse's complete name:
Date and place of your marriage: __
Parents: father mother
Complete name:
Date and place
of birth:
of death:
Date and place of
your parent's marriage:
Grandparents: grandfather grandmother
Complete name:
Date and place
of birth:
of death:
Date and place of
your grandparents' marriage:
Signature:
Date:
Enclosed: 15 $ One year regular membership
50 $ One year benefactor membership
200 $ Life membership
Send completed application with your check made to:
Association des Familles Messier Inc.
c/o David Messier
167 avenue Bazin
Laval, QC
H7N 4P9
Tél.: 514 827-8544
Last update: October 6, 2018