Membership Application |
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| Family Name : | |
| First Name(s) : | |
| Address : | |
| City : | |
| Province/State : | |
| Country : | |
| Postal Code : | |
| Phone (Home) : | |
| Phone (Work) : | |
| Cell Phone : | |
| E-Mail : | |
| Tarification : | |
| Electronic Newsletter □ 12 months 30,00 $ □ 24 months 50,00 $ |
Paper Newsletter □ 12 months 40,00 $ □ 24 months 70,00 $ |
| Member # (in case of renewal) : | |
| Signature : | |
| Date : | |
Join a check payable to :
L'Association des familles Robitaille
| L’Association des familles Robitaille inc. C.P. 47007, Succ. Sheppard, Québec, QC G1S 4X1 |
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