Broussard "Beausoleil" Family Association

Membership Application
and/or Address Correction
Please Print and Mail to Address Below with funds U. S. only


Name: ______________________________________________________________________________

Address_____________________________________________________________________________

City ____________________State__________________ZIP__________Phone__________________
E-Mail Address:________________________________________

Spouse (maiden name for wife)_______________________________________________________

Childrenís names: ___________________________________________________________________

______________________________________________________________________________________

Fee: $10 for family per year, or $25 for 3 years (includes unmarried children to age 18)________________

Lifetime $250: per family (note, married children, or children who attain age 18 years, require
separate membership)____________________

Name of Parents (Include motherís maiden name)______________________________________

_______________________________________________________________________________________

YOUR SIBLINGS_______________________________________________________________________

Name of Grandparents (Paternal, include grandmotherís maiden name)__________________ __________________________________________________                                       
 
(Maternal, please include grandmothers maiden name)_________________________________

_______________________________________________________________________________________

Any additional data you can provide on ancestors: _____________________________________

________________________________________________________________________________________

ANY SPECIAL LIKES or DISLIKES?______________________________________________________

Do you, your spouse, your children, or anyone in your family speak French?

If so, which member:_______________________, Speaks___________, Reads__________

Mail To:
Famille "Beausoleil" Broussard Association
c/o Kim V.  Broussard
214 Highland Drive
Lafayette, La.  70506

e-mail:  crbrouss@bellsouth.net

                                                      

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