Membership Request

Membership
•Reg.: 25$ CAN./year or 25$US (bank fees includes)
•5 years: 100$ CAN. or 100$US (bank fees included)
•Benefactor: 50$ CAN. and more/year

Click here to download printable pdf file
or complete on line, write your check to:

Association des familles Demers inc.

and mail care of:

Luc Demers, Trésorier
1190 chemin Vire-Crêpes
Lévis, Qc, Canada G7A 2B2
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PLEASE NOTE THAT SOME FIELDS ARE MANDATORY

Member Number (in case of a renewal)

Last Name (mandatory)

First Name (mandatory)

Spouse last name

Spouse first name

Address (mandatory)

City (mandatory)

Postal code (ZIP)(mandatory)

Country (mandatory)

Phone Home

Phone Work

Birthplace

Birthdate (yyyy-mm-dd)

Wedding place

Wedding date (yyyy-mm-dd)

E-mail (mandatory)

MY PARENTS

Father's last name

Father's first name

Mother's last name

Mother's first name

Wedding place

Wedding date (yyyy-mm-dd)

THE SPOUSE'S PARENTS

Father's last name

Father's first name

Mother's last name

Mother's first name

Wedding place

Wedding date (yyyy-mm-dd)

MY GRANDPARENTS

Father's last name

Father's first name

Mother's last name

Mother's first name

Wedding place

Wedding date (yyyy-mm-dd)

THE SPOUSE'S GRANDPARENTS

Grand Father's last name

Grand Father's first name

Grand Mother's last name

Grand Mother's first name

Wedding place

Wedding date (yyyy-mm-dd)

MY GREAT GRANDPARENTS

Great Grand Father's last name

Great Grand Father's first name

Great Grand Mother's last name

Great Grand Mother's first name

Wedding place

Wedding date (yyyy-mm-dd)

THE SPOUSE'S GREAT GRANDPARENTS

Great Grand Father's last name

Great Grand Father's first name

Great Grand Mother's last name

Great Grand Mother's first name

Wedding place

Wedding date (yyyy-mm-dd)