Name(s) M./Mme/Mlle_______________________________________________________

Address  ______________________________________________________________

City__________________        Zip+4 ______________ E-Mail(1)__________________________

Phone (      )  _____________________ E-Mail(2) ______________

Membership dues for the '09-'10 season:. .  . Individual $50 ; Couple $75. . . Dues _________
             (....$25/$38 for Feb.'10 thru Aug,'10, if joining after Jan.19)


If you volunteer on the slip, by Sept. 12 to contribute
baked goods towards Tea at one of our Lecture meetings,............ please subtract $5 (_______)
 Mme. Joan Lindsey will contact you to confirm the details of your food contribution.

>>>Enrollment for 10/11-meeting         Conversation Classe Merc. Soir,   $154.00 Fee _________
  (First class starts Weds. Sept. 9, 2009; Enrollment must reach 8 students for the 
    class to be offered, but the classroom limits us to 12-14 students Max.) 

If you would like to make a donation to AFNS to support
our club's programs and defray our club expenses, add that amount here.  .  .  .     $_________


            .....................................Your TOTAL (enclosed)$_________________

Please make your check payable to: Alliance Française du North Shore. 

Return form and payment to: Attn: M. Robert Bonges,Treasurer 
                            c/o P.O. Box 1750,   Evanston,  IL  60204

Your areas of interest?  The success of our francophone group relies on the active 
involvement of our members. Please indicate the 
activities in which you are most interested in participating:

_____Our publicity efforts    ____ Web site          ___ post-lecture Tea&Refreshments
_____Lending Library          ____ Ciné Club          ___ Preparing Centenary Celebration 2012
_____Spring Luncheon          ____ Cercle des Contes   ___ Gathering chapter history
_____Greeting  attendees      ____ Cercle de Lecture    ___ Helping with lining up guest Speakers
_____Café Conversation, AM    ____ Café Conversation,PM  ___ Café Conversation à thèmes
____ Other:______________________________________________


I would like to join the waiting list for:  ____ Cercle de Contes, which usually 
     meets the last Monday of the month at 1:30 p.m. for advanced beginners.. or 
     ___ Cercle de Lecture, for very-fluent and native speakers.. or 
     ___ C.C.à thèmes for intermediate and advanced fluency.


     SONDAGE:  What were your favorite club activities you attended last year, (be specific),
     and,  What Lecture topics do you nominate for future lectures?

     _________________________________________________________________________________________


                    This version of the Membershipform was revised le 3 septembre 2009 par mmo.