CVHS logo

Chateauguay Valley Historical Society

Membership Application / Renewal Form

Name _________________________________________________________________

Address _______________________________________________________________

              _______________________________________________________________

Town/City ___________________________________ Prov/State ________________

Country ___________________________     Zip/Postal Code ___________________

Telephone No ____-____-______   e-mail add. _______________________________


Options

Newsletter
Language
Membership Fees  
English   New   Annual     $30.00Cdn $_______
French     Renewal   Life    $300.00Cdn $_______
Amount Enclosed $_______

Print out this page, complete and mail with payment to:

Elisabeth Churchill,
CVHS Membership Manager,
642 Covey Hill Road,
Havelock, QC
Canada   J0S 2C0