Association Landry 2004

Membership Registration Form

Please fill in the form and press Submit at the bottom of the page.

Last Name
First Name
Address
City/Town
Province/State
Postal Code/Zip
Phone
Fax
Email
Type of Membership
If you choose Family membership list names of other family members incuded

Are you planning to attend the 2004 reunion? (this is not a commitment, just a preliminary poll)

Do you have any suggestions for events or activities at the reunion?

Would you like to help out by making a donation