Fiche d`adhésion anglais - Association d`Aide à la Recherche d

Membership form
Association Aide à la Recherche
d'Anne-Cécile (AARAC)
E-mail :
Address :
AARAC
Les Teppes
73730 SAINT PAUL SUR ISERE
[email protected]
I, undersigned
Mrs
Ms
Mr
First name **
Last name **
wish to be enrolled as member
I wish to contribute :
by supporting the association only*
by participating in poster campaigns*
by participating in events*
by taking a local link responsibility*
with a gift to the association*
check***
Amount :
NB : No membership fee is required to become a member of AARAC.
Date** :
City** :
Signed** :
(Name for electronic version,
preceded by the words "Read and approved")
Your contact :
Address :
E-mail :
Phone number :
* : Check your choice. You can do more than one choice.
** : Required field.
*** : Check made payable to AARAC
IMPORTANT : AARAC association is committed not to disclose your personal data and to remove them from its files on
your request.