APPLICATION FOR ACTIVE MEMBERSHIP

After completing the following form, please print it and send to ASSOCIATION DES ROUSSEL D'AMÉRIQUE, 2099 rue Annette, Mascouche, Qc - J7L1E1. Enclose your cheque in the amount of $20.00 in payment of your fees. Upon receipt, we will send you your password to access the members section.

 

Please fill all boxes
Name and surname:
E-mail:
Address:
City or town:
Zip code
Phone:
Date and place of birth:
Name of your spouse:
Date and place of birth:
Date of marriage:
Married or living common law:
Name of your father:
Name of your mother:
Date and place of their marriage:
Name of your grandfather:
Name of your grandmother:
Date and place of their marriage:
Notes:
   
DECLARATION
I the undersigned, hereby apply as an active member of ASSOCIATION DES ROUSSEL D'AMÉRIQUE and I enclose my cheque in the amount of $20.00

Signature........................................................................... Date.................

Homepage