SUBSCRIPTION FORM

 

Name :  ______________________________________
Birth place :  ______________________________________
Date of birth :  ______________________________________
Father’s name :  ______________________________________
Maiden name of mother:  ______________________________________
Husband name :  ______________________________________
Wedding place :  ______________________________________
Wedding Date :  ______________________________________
Children under 18 years of age :  Oui  Non ____________________________
If yes, how many ?  1  2  3  4 _____________________________
Name of 1st child :  ______________________________________
Name of 2d child :  ______________________________________
Name of 3rd child :  ______________________________________
Name of 4th child :  ______________________________________
Address :  ______________________________________
City :  ______________________________________
Province :  ______________________________________
Postal code :  ______________________________________
Telephon number :  ______________________________________
Email address :  ______________________________________
Type of membership : Canada yearly (25$) 8 years (180$) life (400$)

U.S.A     yearly (30$) 8 years (220$) life (500$)

Europe yearly (35$) 8 years (250$) life (600 $)

Included is a cheque in the amount of ______$ made to the « Association des Faucher et Foucher ».
Membership covers also the wife and all children under 18 years of age.

Signature : ________________________________________

Print this form and send it to the following address :
(don’t forget to include your payment)

Faucher and Foucher’s Association (Châteauvert, Saint-Maurice)
a/s Réal Faucher
601 Caravane
Québec QC G2L 2C7

Brochure to the Association des Faucher et Foucher ( Châteauvert, Saint-Maurice)

Membership application form

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