LEDUC FAMILY ASSOCIATION

In order that we can enter your data in our computer data base, we ask all new members to please fill in this form and mail it to the Association with your annual subscription:
 

         Name ________________________________________

  Surname ________________________________________

  Address ________________________________________

        City ________________________________________

Province ________________________________________

   State ________________________________________

Postal code _________ Country ___________________

Telephone ( ) ___-____ FAX ( ) ___-____

e-mail ___________________________________________

Date of birth ____________________________________

Profession _______________________________________

Would you be interested in having an article published
in the Journal? ___

Are you a descendant of Antoine, Pierre, Jean, René,
Jean-Baptiste or unknown? ________________________

Page hébergée par/This page hosted by