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 allow you to occasionally collaborate on certain projects
Comments

Print this page and mail it to:
C.P. 3571
Lac-Simon, Chénéville, QC
J0V 1E0

Annual Fee: $25

Payment by e-transfer to our email address: assoc.proprietaireslacsimon@gmail.com
Don't forget to write your name and address at the lake when you do the transfer

Or by chèque payable to: Association des Propriétaires du Lac Simon

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