Membership Form
Name:____________________________________________________________Member number:______
Name of spouse: (include maiden name)____________________________________________________
Email address:_____________________________________________Home Phone__________________
Address:_____________________________________________City:_____________________________
State/Province:_________________________________ Zip/Postal code:___________________________
Lineage or ancestor:_________________________________________________________________
(Use backside if necessary)
Type of membership: Full____ Associate ____ Junior____ Age of Junior_____Date of birth:___________
(14 –18 yrs)
Full membership fee (select option) ____ $10 for one year membership
____ $15 for two year membership
____ $20 for three year membership
Fees payable in US dollars. Make checks to: Association of Rivard Cousins
Associate and Junior members do not pay a membership fee, do not get to vote or hold an
office. Each member of the family who wishes to become a member must fill out this form.
I would be willing to work on/with the following committee(s): ARC Webmaster: ____
Newsletter Editor: ____ Project Coordinator: ____ Reunion (RRV) Chairperson: ____
Nominating Committee: ____ Ethics Committee: ____ AIFR Liaison: ____ All of the above: ____
Send this membership form with your check to either:
Marlyss Hernandez, 521 Woodlawn Road, Freeport, Fl 32439
Mary Makuski, 333 Second Street, Stevens Point, Wisconsin 54481
Signature of member: ___________________________________________________
