Quebec Family History Society
Membership / Renewal Form

This form can be completed on-screen and printed on your printer. Or you may print it and then fill it out, using CAPITAL letters.

Family Membership: Up to two persons, at the same address. Our membership year is from August 1 to July 31.
USA orders: Payment can be made by Visa (or by US$ cheque / money order)
Cheques: Please make cheques & money orders payable to Quebec Family History Society.

Date (Sep/15/1949):   Membership # (if renewal):
Mr. / Mrs. / Ms.: 
Applicant - Surname: 
Applicant - Given Name: 
Family Member - Given Name: 
Family Member - Surname: 
Address: 
City: 
Prov / State: 
Country: 
Postal / Zip Code: 
Email: 
Phone: (xxx-xxx-xxxx): 
Are you interested in receiving "CONNECTIONS magazine" electronically ?:
Electronic Delevery: (Yes / No): 
Individual / Family Membership: 65.00 $Can     Institution Membership: 40.00 $Can
Membership Amount:   We always need help in acquiring new resources
(microfilm, microfiche, books, CDs, etc.).
Please consider adding a donation to your membership.
Donation:  
Total Amount:   Do you want a tax receipt?
Tax receipts for donations sent only on request.
Payment method:  Cheque    Money Order    Visa
For Visa:  
Exact name on card:
Card number: Expiration Date: /
When completed, mail this form, with check or money order to:
The Quebec Family History Society         ATTN : Membership
P.O. Box 1026, Pointe-Claire, QC
Canada     H9S 4H9