Registration Form

First Name:
Last Name:
Lac Simon Address
Address:
Postal code:		Phone:
Municipality/Sector:	Lac Barrière Lac-Simon Duhamel ICB
Correspondence address (if different)
Address:
Town:		Province:
Postal code:		Phone:
Email:
Areas of expertise, occupation or interest that you would occasionally collaborate on certain projects
Comments

Annual Fee: Owner: 25 $ / Associate: 20 $

Make your check to: Lac Simon Property-Owners’ Association

Print and mail to:
Box 3571
Lac-Simon, Chénéville, QC
J0V 1E0

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