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 Registration
- 1 year : $ 35 Ο
- 2 years : $ 65 Ο
- 3 years : $ 90 Ο
- Student rate : $ 10 Ο
Please send this form (with your check or after direct deposit) to :
L’Association des Normand d’Amérique
1033 rue de la Colombière, Lévis, Québec G6Z 2J4
Thank you!