Gaspé-Jersey & Guernsey Association  


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Qui sommes-nous?

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Membership Application


Print and mail to:                              or/ou                    Imprimez et mallez à: 

Jean-Claude Dumaresq                                                 Association Gaspé-Jersey-Guernesey
165-A, rue Renard Est                                                   1208, côte du Monument
Gaspé, Qc. Canada   G4X 5K9                                      Gaspé,  QC   G4X 6T6


I wish to become member of your Association.         Je souhaite adhérer à votre association,

Name (First Name, Surname)     (Prénom et Nom)


Complete Address


Telephone Number


E-Mail Address:  Courriel


 Regular  Member   -   $10.00                  -   Membre régulier   $10.00

 Benefactor member - $20.00 or +             -  Membre bienfaiteur.    $20.00 ou +  

Note, membership renewable annually in January, no billings, reminder in Newsletter.            Carte renouvelable en janvier, aucune facturation, rappel dans le bulletin. 

Families or events being researched  / Recherches familles ou événements sur: 


I undersigned, agree to observe all rules set forward by your regulations. 
Je m'engage à observer tous les règlements de l'Assocaitioon Gaspé-Jersey & Guernesey 


Signature
Date


Sponcer: : Parrain