Formulaire d`Adhésion

www.3af.fr
3AF-Membership Relations
6, rue Galilée – 75116 Paris – France
Tel : +33 1 56 64 12 30
Fax. : +33 1 56 64 12 31
Email : [email protected]
REGISTRATION FORM
INDIVIDUAL
MEMBERSHIP
Secrétariat Exécutif : 6 rue Galilée - 75016 Paris - France  Tél. : +33(0)1 56 64 12 30
Fax : +33(0)1 56 64 12 31  E-Mail : [email protected]  Web : www.3af.fr
REGISTRATION FORM
Once completed, please send this form to the Executive Secretariat of the Association Aéronautique et de France :
By email
[email protected] – Objet : « 3AF Membership »
By Fax
00 33 1 56 64 12 31
Please complete all fields marked with (*) as these are required for our administration. Please fill in your form as completely as possible
especially when it comes to your contact details and your preferences. You will be able to change your profil at any time on our 3AF website.
Date :
1. MY ACCOUNT
NAME *
Caterory *
First Name *
Student (less than 30 years old - a copy of your student card is required)
Are you at present on a training course ?
Yes
No
Young Professional (less than 30 years old)
Professional (up to 30 years old)
Retired
Your email address will be your Id on the 3AF website.
Email address / id *
Please enter a password with a minimum of one letter and one number. This password will be required on the 3AF website
Password *
2. MY CONTACT DETAILS
2.1 Identity
Marital Status*
Title
Mr.
Doctor
Mrs.
Miss
Professor
Middle name
Date of Birth (DD/MM/YYYY) *
Place of Birth
Nationality
: ………………………………………………………..
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Reconnue d’utilité publique (décret du 7 février 1972) membre de l’International Council of Aeronautical Sciences (ICAS), de l’International Astronautical Federetion (IAF),
de l’Association Française de Mécanique (AFM), de l’International Society on Air-Breathing Engines (ISABE) et du Council of European Aerospace Societies (CEAS).
Siret : 775 689 268 00057 - APE 913E
2.2 Personal details
Address line 1 *
Address line 2
Post Code *
TOWN *
Country *
Phone number
Mobile
Fax
Additional phone number or mobile
Email address A
2.3 Professional details A
Your Company
Address line 1
Address line 2
Post Code
TOWN
Country *
Phone number
Mobile
Fax
Email address
2.4 Details to be published on the 3AF Directory (contact details)
Personal details :
Personal address
Phone number
Mobile
Email
Fax
Additional phone number or mobile
Professional details :
Professional address
Phone number
Mobile
Email
Fax
3. MY PROFILE
3.1 Professional Skills
Professional Title
Additional information :
………………………………………………………………………………….………………………………………………………………………….
……..………………………………………………………………………………………………………………………………………………………………...
……………………………………………………………………………………………………………………………………………………………………….
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In order to qualify your current position, please define a product (eg : Motors), a job (eg : Design) and a technical skill (eg : Acoustics) as well as
the associated level of expertise (eg : 2). You can associate more than one triplet product / job / technical skill to your current position. Please
select what is the most applicable to your case.
Choose between the following products :
• Aeroplanes
• Battery
• Cells Engines
• Electrical Systems
• Electronical Components
• Engines
• Hardware
• Helicopters
• Landgears
• Launchers
• Materials
• Missiles
• Structures
• Telecommunication Networks
• Other Components
Choose between the following occupations :
• Management
• Process
• Resarch & Development
• Supports
Choose between the following technical skills :
• Aerodynamics
• Automatics
• Electromagnetics
• Electronics
• Energy
• Fiability
• Fluids Mechanics
• Guidance, Control
• Hyperfrequency
• Materials
• Mechanical / Electrical Architectures
• Navigation
• Optronics
• Propulsion
• Radar
• Signal / Image processing
• Simulation
• Structures
• Softwares
• Telecommunication
• Testing (ground / flight)
• Thermics
3.2 Technical Skills
Product : ......................................................................................................................
Job : ........................................................................................................................
Technical skill : ........................................................................................................................
Level of Expertise : .............................................................................................
3.3 Schools / Universities
You will have the possibility to indicate only two schools / universities on this registration form. However, you will be able to register additional
school / university directly on our 3AF website.
School / University 1
School
Education
Additional information
Year in which this education is expected to end
Are you currently studying in this establishment ?
Yes
No
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School / University 2
School
Education
Additional information
Year in which this education is expected to end
Are you currently studying in this establishment ?
Yes
No
3.4 Decorations and Awards
Please indicate any of your decoration in full (ex. Ordre National du Mérite – Chevalier, 3AF Aeronautical Price, 3AF Graduates…).
Decoration
Decoration/Award
Grade
Year
Decoration 2
Decoration
Grade
Year
4. TECHNICAL COMMITTEES
Technical Committees are group together on specifics themes relating to the aeronautical and space sector. Please indicate below which
interest you the most. You will have to indicate your motivations in joining the choosen technical committee and to list the skills you would be
bringing to the committee. The President of the technical committee you chose to join will study your application.
You will have the possibility to indicate your interest for only three technical committees on this registration form. However, you will be able to
choose additional technical committees on our 3AF website.
Aerodynamics
Business Intelligence
Commercial Aviation
Energetics
History
Intellectual Property
International Strategy
Light Aircraft
Materials
Missiles Space Exploration and Observation
Optronics
Propulsion
Rotorcraft
SIGMA (unidentified Aerospace Phenomena)
Space Exploration and Observation
Space Transportation
Structures
Test and Evaluation
UAV
Technical Committee :
………………………………………………………………………………….…………………………………………………………
……..………………………………………………………………………………………………………………………………………
Your motivations :
………………………………………………………………………………….…………………………………………………………
……..………………………………………………………………………………………………………………………………………
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5. SETTLEMENT
Please indicate your category of membership :
Student
Young Professional (up to 30 years old)
Professional (30 years and olders)
Teacher
Retired
Contributor
15 €
50 €
130 €
85 €
70 €
→
Total :
The settlement of your Membership fees entitles you to receive the 3AF Letter, the members’ directory, access to restricted files on
our 3AF website reserved to members only and also to get dedicated rates for conferences, workshops and symposia organized by
3AF. In addition, an electronic newsletter is regularly sent to members.
5.1 Please indicate your payment
By check (only for French bank account holder) ordered to « 3AF » to be sent to : 3AF, Relation membres, 6 rue Galilée, 75116 Paris,
FRANCE
By International Bank transfer
IBAN : FR 76 30003 03300 00037260771 18 ; SWIFT Address : SOGEFRPP
5.2 Invoice
My Company will settle my AAAF membership
Your Company is settling your membership fee, please make sure that an order form will be sent to the 3AF Executive Secretariat before
processing. The invoice will be then sent to your company directly.
I wish to receive an invoice in order to transfer it to the appropriate department for settlement.
Les informations recueillies font l’objet d’un traitement informatique destiné à favoriser l'adaptation des activités de l'Association Aéronautique et Astronautique
de France aux attentes de ses membres individuels et collectifs. Les données sont accessibles aux responsables locaux et nationaux ainsi qu’au Secrétariat
Exécutif du Bureau National de l’association.
Conformément à la loi « informatique et libertés » du 6 janvier 1978 modifiée en 2004, vous bénéficiez d’un droit d’accès et de rectification aux informations qui
vous concernent, que vous pouvez exercer en vous adressant au Secrétariat Exécutif du Bureau National de l'Association Aéronautique et Astronautique de
France : 3AF, 6 rue Galilée, 75116 PARIS. Vous pouvez également, pour des motifs légitimes, vous opposer au traitement des données vous concernant.
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