Formulaire d’adhésion – E – Association des Familles Messier

Membership Application

Please complete the following form to become a member of the Messier Family Association…

First and last name

date your your

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

Date of birth

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... please 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 parent's marriage

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

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

Date and place of your grandparent's marriage

Comments or questions?

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

Regular member and electronic journal: $20 membership fee
Regular member and print newspaper: $25 membership fee
Benefactor member: $50 fee (please specify your preferred newsletter format)
Lifetime member and electronic journal: $225 fee
Lifetime member and print journal: $225 membership fee + $15 per year

If you have chosen to be a benefactor member, in what format would you like to receive your journal?

Electronic
Paper

Please note that our newspaper "La Moisson des Messier" is included in your contribution and your membership is confirmed once we received your dues.

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

Members residing in the

United States

must pay in US dollars.

You can send us

your duly completed form

and your check by regular mail to the following address:

Association des Familles Messier

a/s David Messier

167 avenue Bazin

Laval, QC

H7N4P9

You can send us

your form electronically (We will receive it as soon as you click the « Send » button above), and
your Interac e-Transfer by addressing it to:

famillemessierfamily@gmail.com

Printable Form in Word :

Click here