Formulaire d’adhésion-v2 – Association des Familles Messier

Membership Application

Please complete the following form to renew your membership card for the Association des Familles Messier…

First name and last name

Address, City, Postal code (or Zip Code)

Phone number

I authorize Association des Familles Messier to publish my email address

Date and Place of birth

Marital status

In a relationship... Full name of your current spouse or partner, as well as the date and place of your marriage (if applicable). List any previous unions on the "Comments or Questions" line.

Other... specify your status

Your father: Full name, date and place of birth, and date and place of death (if applicable)

Your mother: Full name, date and place of birth, and date and place of death (if applicable)

Date and place of your parents' marriage:

Your paternal grandparents. For each: full name, date and place of birth, date and place of death (if applicable), as well as the date and place of their marriage.

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Your maternal grandparents. For each: full name, date and place of birth, date and place of death (if applicable), as well as the date and place of their marriage.

Questions, comments, or additional information

Under which status do you wish to register, and in which format do you wish to receive our journal?

Regular member and log in the format electronic : $20 membership fee
Regular member and log in the format paper : 25$ membership fee
Benefactor Member and log in the format electronic : 50$ Membership fee
Benefactor Member and log in the format paper : 50$ Membership fee
Lifetime Member and log in the format electronic : 225$ Membership fee
Lifetime Member and log in the format paper : Membership fee: $225 + $15 per year

Please note that our newsletter, "La Moisson des Messier," is included with your contribution, and your membership is confirmed upon receipt of your dues.

I will send you a check today
I'm sending you an Interac e-Transfer.

Resident members in the

United States

must pay in US currency.

You can send us

your duly completed form and your check by regular mail

at the following address:

Association des Familles Messier

a/s Réjean Messier

1621 rue St-Gérard

St-Alexandre, QC

J0J 1S0

You can send us

your form electronically (it will reach us as soon as you click the "Submit" button above), and
your Interac e-Transfer by sending it to us at:

famillemessierfamily@gmail.com

Printable Word form:

Click here