Annual Membership form / renewal

Available online or by mail!

To become a member or to renew your membership by mail,

Print the above form, fill it out

and send it to the following address:

AQDMD
102-1490 Chemin de Chambly
Longueuil (QC) J4J 3X3

AQDMD Membership and Renewal Form

Identification

Title *

First name *

Name *

Address *

Address line 2

City *

Province *

Postal Code *

Region *

Phone

Email *

Age group *

Organization name

Yearly contribution (20.00 $) Please note that we now issue tax receipts for all donations of $10 or more.

Contribution

Add a supplemental amount

Donation Type

Total amount

Other

I wish to get involved

I wish to subscribe to the newsletter

Preferred communication language

Note to registry