ALLIANCE FRANCAISE DE MALTE ~ MEDITERANEE MEMBERSHIP

A LLIANCE F RANÇAISE DE M ALTE - M EDITERRANEE
M EMBERSHIP
Mr / Mrs / Ms / Dr ________________________________________________________
Address:
____________________________________________________________
____________________________________________________________
________________________
Telephone
Post code: ________________________
home:
_________________________
work:
_________________________
mobile:
_________________________
Email address: __________________________________________________________
Profession: ____________________________________________________________
Date of birth: ______________________
Nationality: _________________________
Data Protection:
In keeping our membership records, personal data is inevitably kept about our members. You should be aware
that the data processing of such data is necessary in order to give you a better service and to keep track of our
mutual obligations. We exercise utmost confidentiality and only disclose such personal data to selected
personnel or other third parties for the purposes of lessons, exams or other activities to which you participate.
You have the right to access your personal data, and to rectify it where appropriate, by directing your request in
writing to the director of the Alliance Française de Malte ~ Méditerranée.
I, the undersigned, would like to apply for / renew my membership with the Alliance Française
de Malte ~ Méditerranée for the coming year.
Regular Member
€15 
Library deposit
€15 
Ami de l’Alliance
€150 
DVD deposit
€20 
Ami en Or (companies)
€500 
DVD rental (for 12 DVDs)
€14 
Deposits are recovered when you decide to terminate borrowing
from our library and all the material borrowed is returned.
Date : ________________
Signature : ____________________________
FOR OFFICE USE ONLY
Membership number: _________________
Payment cheque / cash: ________________
A LLIANCE F RANÇAISE DE M ALTE - M EDITERRANEE
C OTISATION
M / Mme / Mlle / Dr _______________________________________________________
Adresse:
____________________________________________________________
____________________________________________________________
________________________
Téléphone
Code Postal: ______________________
domicile :
_________________________
bureau :
_________________________
portable:
_________________________
Adresse mail: ___________________________________________________________
Profession: _____________________________________________________________
Date de naissance : ______________________
Nationalité: ____________________
Data Protection:
In keeping our membership records, personal data is inevitably kept about our members. You should be aware
that the data processing of such data is necessary in order to give you a better service and to keep track of our
mutual obligations. We exercise utmost confidentiality and only disclose such personal data to selected
personnel or other third parties for the purposes of lessons, exams or other activities to which you participate.
You have the right to access your personal data, and to rectify it where appropriate, by directing your request in
writing to the director of the Alliance Française de Malte ~ Méditerranée.
Je, soussigné(e), souhaite demander ou renouveler mon adhésion à l'Alliance Française de
Malte ~ Méditerranée pour l'année à venir.
Cotisation Membre
€15 
Caution bibliothèque
€15 
Ami de l’Alliance
€150 
Caution médiathèque
€20 
Ami en Or (entreprises)
€500 
Emprunts de DVD (pour 12 DVDs)
€14 
Le montant des cautions est récupéré a la cessation de
l’utilisation de facilites, une fois tout le matériel emprunte rendu.
Date : ________________
Signature : ____________________________
SERVICE D’ADMINISTRATION
Numéro de membre: ____________________
Règlement cheque / espèce: ________________