05/13/04

Membership fee of $10 per family with children under 18, and $5 for single membership.

5626 MELLING AVE., CÔTE SAINT-LUC, QUÉBEC, CANADA H4W 2C2

514-489-0985

M E M B E R S H I P    F O R M

(2003-04)

FAMILY NAME:

FAMILY: HUSBAND (first name):                                        WIFE (first name):

                        Children (first names):

Single person (first name):

ADDRESS:

PHONE NO.:

FAX NO.:

E-MAIL:

ARE YOU INTERESTED IN HELPING OUT IN THE ACTIVITIES OF THE ASSOCIATION 

 YES (   )                       NO (    )

IF YES, PLEASE SPECIFY:

            HINDI TEACHING (   )

            CULTURAL ACTIVITIES (    )

            OTHER   (    ), SPECIFIY