Famille LeBlanc

Please print this application and complete and mail with $12.00 dues to:
Mr. Carroll LeBlanc, Treasurer-Famille LeBlanc
612 Cambridge Drive, Lafayette, La.  70503

(Note:  Lifetime memberships are available; contact the President for details)

Membership Application #                   

La Famille de Le Blanc, Inc. --Date:

Individual's Name

 

 

 

Name-1st

Name-2nd

Name-Last

DOB

 

 

 

 

 

 

 

 

Spouse's Name

 

 

 

Name-1st

Name-2nd

Name-Last

DOB

 

 

 

 

 

 

 

 

Location

 

 

 

1st street address

2nd street address

City/State

ZIP

 

 

 

 

 

 

 

 

Home Phone

Cell Phone

E-mail

 

 

 

 

 

 

 

 

 

Marriage Info

 

 

 

Church Name

City/State

 

Date

 

 

 

 

 

 

 

 

Kids' Names

Birthplace/City/State

 

DOB

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Individual's Father's Name

 

 

 

Name-1st

Name-2nd

Name-Last

DOB

 

 

 

 

 

 

 

 

Individual's Mother's Name

 

 

 

Name-1st

Name-2nd

Name-Last

DOB

 

 

 

 

 

 

 

 

Marriage Date:

 

City/State

 

 

 

 

 

Spouse's Father's Name

 

 

 

Name-1st

Name-2nd

Name-Last

DOB

 

 

 

 

 

 

 

 

Spouse's Mother's Name

 

 

 

Name-1st

Name-2nd

Name-Last

DOB

 

 

 

 

 

 

 

 

 

 

 

 

Marriage Date:

 

City/State

 

Please provide names, DOB, address & marriage data for paternal and maternal grandparents on the reverse side of this form.

For Pot-luck dinner (please define)  I will bring__________dessert or___________dish.
Would you like to serve your association on a committee, the Board, or as an officer?
                                              RSVP:Yes____   No_____
 

Click for:  Officers       Membership Application       Feb. 2009 Newsletter       Feb. 2008 Newsletter
                                                                 
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