> Annual Membership form

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

Formulaire d'adhésion et de renouvellement à l'AQDMD

Identification

Title

First name*

Name*

Email*

Organization name

Address*

City*

Administrative region

Province*

Postal Code*

Phone

Only enter numbers

Yearly contribution (20.00 $)

Contribution

Add a supplemental amount

Monthly contribution

Total amount

Note to registry

I wish to get involved

Interested

Désire recevoir l'infolettre

Interested

Preferred communication language

French English