Association des Landry de la Nouvelle-Ecosse Those planning to attend the Landry Family Reunion on August 7,8,9, 2004, please fill out the following Membertship Registration Form and mail it today. Richard needs a head count in order to complete the plans for the re-union. ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ Formulaire d'Inscription Membership Registration Form Nom / Name: ____________________________________________ ________________________________________________________ Adresse / Address: _______________________________________ ________________________________________________________ Code Postal / Postal Code: _________________________________ Téléphone / Telephone : _________ Téléc. / Fax: _____________ Courriel / E-mail: _________________________________________ Individuel / Individual 10,00$ / $10.00 Famille (Membres sous la Meme toit) Family Members (Under the same roof) 15,00$ / $15.00 Noms des autres membres de la famille inclus/ Names of other family members included __________________ ______________________ _________________ _________________ ______________________ __________________ Inscription en vigueur de la date du paiement au, et incluant, le 14 août 2004 Registration effective from date of payment to, and including August 14, 2004 Signature __________________________________ Date: ______________ Envoyer avec paiement a / Send with payment to: Association des Landry de la Nouvelle-Ecosse a/s - c/o Richard Landry Boite / Box 168, RR 1 Saulaierville, Nouvelle -Ecosse / Nova Scotia B0W 2Z0 Canada