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

Important :

Please note that the option “complete online”  is not functional so, click on the link below and follow instructions…

Click here to download printable pdf file

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)