Membership Form

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



Name : .................................... First name : ...........................................Date of birth : YYYY / MM / DD



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

ou

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

144 de Trieste, Vimont
Laval, Qc, H7M 1P1


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