Richelieu Lége/Léger/Legére Family Assoc. Inc.

Membership Renewal

(Please circle one)


Types of Membership
:   Lifetime:  $300       Annual:  Family-$15.00     Single: $10.00

Member's Full Name (Nom)(person who is Leger descendent):
 
_____________________________________________________________________________
   Last 
(Nom de famille)                   First (prenom)                    Maiden/Middle(deusiemme prenom)
 

Address: (Adresse):_____________________________________________________________
                                  Street 
(Rue)                             P O Box (boite postal)

City (Ville)______________________State (Etat)____________Country (Pays)______Zip:____

Home Phone:(       )____________________Work Phone:(        )_________________________

FAX:_____________________________E-Mail:________________________________

Please print and mail completed form and payment (U S Funds Only) to:
 (retournez le formulaire et le paiement a):

The Richelieu Leger Family Association, Inc.
c/o Joyce H. Lege
1125 Coulee Kinney Dr.
Abbeville, La.  70510
*****************************************************************************************************
For Record Use Only: (To be completed by membership chairperson)
Amt:___________ Date Rec'd:___________Membership Card:___________

Cash:__________Check No.:___________ Check Dated:_______________

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