Membership Form

Print this form to complete and mail your check or money order.

Name : .................................... First name : ...........................................

Names and surnames of father and mother (maiden name) ......................................................................

First and last names of the paternal grandparents ........................................................................

First and last names of maternal grandparents ........................................................................

Name of spouse : .........................................................................................

Address : ...............................................................................................

City, province or state and postal code : ..............................................................................

I was made aware of the association : ........................................................................

Email : ................................................................

(Can we say your e-mail to our members) YES [......] NO [......]

I would prefer to receive the newsletter of the association in French [......] in English [......]

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

Regular Membership : 20.00$ (Annually).

Interac Email Payment :
Canadian currency only
AFCCAN@andre-carriere.qc.ca

Make a check or money order to :
Carrier and Carrière Families Association of North America

Thank you. An association can survive without its members. Joining us is helping us grow.