Richelieu Lége/Léger/Legére Family Assoc. Inc.

Membership Application

Types of Membership Lifetime:  $300;      AnnualFamily-$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)
If you go by a name other than the first name listed above, please indicate here____________

Parent's Full Names (Leger):_____________________________________________________

Grandparent's Full Names (Leger):_________________________________________________
(If you have more information on your ancestors, please send on separate sheet or on back of this form)

Spouse's Full Name_____________________________________________________________
       
(espoux/epouse) Last (Nom de famille)            First (prenoum)      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:________________________________

Other family members in your household:
Name:___________________________________  Relationship to member:________________

Name:___________________________________  Relationship to member:________________

Name:___________________________________  Relationship to member:________________

Please print and mail completed form and payment (U S Funds Only) to (retournez leformulaire 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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