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Richelieu Lége/Léger/Legére Family Assoc. Inc. |
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Membership Application |
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| 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) 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_____________________________________________________________ Address: (Adresse):_____________________________________________________________ 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:________________ 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.
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