Registration Form for Membership or Renowal

 

 

Registration Form for New Membership or Renewal

 

Name :  _______________________     Firstname  :  ____________________                                   

Member number : ____________

        Postal address:  _________________________________________________
        City: _______________________       Province or State:  ________________

        Postal Code or  Zip Code:  ___________________

        Home phone:   ____________________    Cellular:  _______________________
        E-mail address :  ___________________________________________________

         Duration of Regstration

          • 1 year :            $ 35      Ο
          • 2 years :          $ 65      Ο
          • 3 years :          $ 90      Ο
          • Student rate $ 10      Ο

 

        Please attach your check to this form and send it to :

 Association des Normand d’Amérique 

1033 rue de la Colombière, Lévis, Québec G6Z 2J4

Thank you!