Associate Membership/Membership Form

ALLIANCE FRANCAISE ''LE CORBUSIER'' DE CHANDIGARH
next to Hibiscus Garden Sector 36 - A, CHANDIGARH - 160036 ! : 2668627
FORMULAIRE D’ADHÉSION
Associate Membership Form ! SINGLE ! COUPLE
PLEASE ATTACH A PHOTOGRAPH AND A PHOTO IDENTITY CARD
Single Membership
(♀/♂)
For Couple Membership(spouse/husband)
(Fill both sides)
NOM :___________________________________________
NOM
Surname
PRÉNOM :____________________________________
First Name
PROFESSION
:___________________________________
Surname
PRÉNOM :____________________________________
First Name
:______________________________
PROFESSION
DATE DE NAISSANCE:___________________________
:______________________________
DATE DE NAISSANCE:___________________________
Date of Birth
Date of Birth
DOMICILE : _____________________________________________________________________________________________
Address
______________________________________________________________________________________________________
tel : ____________________________________________ E-mail : ______________________________________________
NIVEAU DE FRANÇAIS:
LU (1,2,3)
PARLÉ (1,2,3)
Level of French
Read
Speak
ÉCRIT (1,2,3)
Write
1
2
3
débutant
intermédiaire
avancé
DIPLÔMES EN FRANÇAIS :__________________________________________________________________________
Diplomas/Degrees in French
AUTRES LANGUES:_______________________________________________________________________________
Other Languages
MOTIVATIONS POUR DEVENIR MEMBRE:________________________________________________________________
Reason for becoming a member
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Note :
Associate Membership is subject to approval by the General Secretary and the President of the Alliance Française “Le Corbusier”
de Chandigarh.
Associate Membership is for one financial year, from 1st April to 31st March and has to be renewed every year.
Associate Membership will not be entitled to attend any General Body Meeting, nor to vote during the elections of the Alliance
Française “Le Corbusier” de Chandigarh.
The annual Associate Membership fee is Single Membership: Rs.650+ 98/-=748/-, Couple Membership: Rs.750+113/-=863/-.
Incl of Service Tax
The annual membership of the library is Rs 500/- + with 1000 as refundable security + S.T.
FACILITIES AVAILABLE TO THE ASSOCIATE MEMBERS INCLUDE:
Access to the Alliance Française library ( for consultation of French books, magazines, newspapers) Video library for French
Movies. For borrowing books, magazines, cassettes, CD’s, CD ROM’s, you will have to abide by the rules and regulations of the
Alliance Française library.
Viewing of weekly French Films (with English sub-titles) screened at the Alliance Française.
Invitations to all cultural events organised by the Alliance.
A bi-monthly bulletin of the Alliance Française.
Associate Member can enter the library, Café or any cultural event on simple presentation of Alliance Identity Card.
Receipt No.
Date :
Signature :
ALLIANCE FRANCAISE LE CORBUSIER DE CHANDIGARH
next to Hibiscus Garden Sector 36 - A, CHANDIGARH - 160036 ! : 266 86 27
FORMULAIRE D’ADHÉSION
Membership Form ! SINGLE ! COUPLE
Single Membership
(♀/♂)
For Couple Membership(spouse/husband)
(in case of couple kindly fill both parts)
NOM :___________________________________________
NOM
Surname
PRÉNOM :____________________________________
PRÉNOM :____________________________________
First Name
PROFESSION
:___________________________________
Surname
First Name
:______________________________
PROFESSION
DATE DE NAISSANCE:___________________________
:______________________________
DATE DE NAISSANCE:___________________________
Date of Birth
Date of Birth
DOMICILE : _____________________________________________________________________________________________
Address
______________________________________________________________________________________________________
tel : ____________________________________________ E-mail : ______________________________________________
NIVEAU DE FRANÇAIS:
LU (1,2,3)
PARLÉ (1,2,3)
Level of French
Read
Speak
ÉCRIT (1,2,3)
Write
1
2
3
débutant
intermédiaire
avancé
DIPLÔMES EN FRANÇAIS :__________________________________________________________________________
Diplomas/Degrees in French
AUTRES LANGUES:_______________________________________________________________________________
Other Languages
MOTIVATIONS POUR DEVENIR
MEMBRE:______________________________________________________________________________________
Reason for becoming a member
_____________________________________________________________________________________________
Note :
Membership is subject to approval by the Executive Committee of the Alliance Française “Le Corbusier” de Chandigarh.
-
st
st
st
Membership is for one financial year, from 1 April to 31 March and has to be renewed every year between the 1 of January
st
and the 31 of March for the subsequent financial year.
Membership will be entitled to attend any General Body Meeting, to vote during the elections of the Alliance Française “Le
Corbusier” de Chandigarh.
The annual Membership fee is Single Membership: Rs.550/-, Couple Membership: Rs.650/-. + Service Tax 14 %
The Life Membership for Single Membership is Rs.20,00/-, Couple Membership Rs.25000/- + Service Tax 14%
Members have to pay Rs.1000 as refundable security to avail the facilities of the library.
FACILITIES AVAILABLE TO THE MEMBERS INCLUDE:
Access to the Alliance Française library (for consultation of French books, magazines, newspapers) Video library for French
Movies. For borrowing books, magazines, cassettes, CD’s, CD ROM’s, you will have to abide by the rules and regulations of the
Alliance Française library.
Viewing of weekly French Films (with English sub-titles) screened at the Alliance Française.
Invitations to all cultural events organized by the Alliance.
A bi-monthly bulletin of the Alliance Française.
Member can access the library, Café or any cultural activities on simple presentation of Alliance Identity Card.
Date :
Signature :
For Office use
Receipt no.................dated......................Amount.................