___________________________________________________________________________
Print in this form and return it by mail with your cheque or money order to:

ASSOCIATION DES FAMILLES BOISVERT INC.
C.P. 10090 Succ. Sainte-Foy,
Québec (Québec) G1V 4C6

New membership [_____] ou Renewal [______]
Membership number [_______] if applicable

Name:____________________________________________________________________

Address:__________________________________________________________________

Municipality: _______________________        Postal Code : ________________________

Tel:(___)___-_______________________        Telephone at work: (___) ___-___________

Fax number: (___) ___-_______________        Internet Address: _____________________


[__] Regular membership: $22.00 in Canada an 30$ out of Canada per year
[__] Additional family member: $5.00 per year
[__] Benefactor: $25.00 or more
Date: ____________ Signature:   ____________________

Genealogical Information:

Father's name : _________________________________________________________
Mother's name :_________________________________________________________
Date and place of marriage (Parish) : ____________________________ ___________
Grand-Father's name :____________________________________________________
Grand-Mother's name : ___________________________________________________

Date and place of marriage (Parish) : ________________________________________

Please send us any genealogical information you may have.

We'll send you your «Boisvert Family Tree» on parchment

free of charge.