phuket tphuke bulletin d`adhesion 2016

 UNION DES FRANÇAIS DE L’ETRANGER
Représentation de Phuket – Thaïlande
PHUKET
TPHUKE
TTE
BULLETIN D’ADHESION 2016
Normal
Réduit
(Retraite,Etudiants)
Simple
1.800 baht
1.500 baht
1.800 baht
Couple
2.800 baht
-
2.800 baht
Tarifs
TTETEK
E
71/45 Moo.2, T. Kathu, A. Kathu, Phuket 83120
P.O. Box 32, Kathu, Phuket 83120
E-mail: [email protected] / Website: http://www.ufe-phuket.org.
TTEETT
TTT
Amis de l’UFE
Madame – Mademoiselle – Monsieur (Rayez les mentions inutiles)
NOM…………………………………………………………………………….................…………………………………………
PRENOM…………………………………………………………………………………………………...……….........................
DATE DE NAISSANCE……………………………………………………………………………………………………………...
TEL FIXE……………………………………………..TELEPHONE MOBILE……………………………………………...........
NATIONALITE………………………………………………………………………………………………………………………..
E-MAIL ……………………………………………………………………………………………….............................................
PROFESSION………………………………………………………………………………………………………………………..
ENTREPRISE…………………………………………………………………………………………………………………..…....
CONJOINT
Madame – Mademoiselle – Monsieur (Rayez les mentions inutiles)
NOM…………………………………………………………………………………………………………………………………...
PRENOM……………………………………………………………………………………………..............................................
DATE DE NAISSANCE……………………………………………………………………………………………........................
TEL FIXE……………………………………………..TELEPHONE MOBILE……………………………………………………
NATIONALITE………………………………………………………………………………………………………………………..
EMAIL ………………………………………………………………………………………………..............................................
PROFESSION………………………………………………………………………………………………………………………..
ENTREPRISE………………………………………………………………………………………………………………………...
ADRESSE……………………………………………………………………………………………………………………….……
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CODE POSTAL…………………………VILLE……………………………………………..PAYS………………………………
ADRESSE POSTALE (si différente)……………………………………………………………………………………………….
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CODE POSTAL…………………………VILLE…………………………………………….PAYS……………………………….
INFORMATIONS COMPLEMENTAIRES : …..……………………….……………………………………………………..……
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Union des Français de l’Etranger
ASSOCIATION LOI 1901 RECONNUE D’UTILITE PUBLIQUE, FONDEE EN 1927