formulaire adhésion test .pdf

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Original filename: formulaire adhésion test.pdf
Author: Audrey Bellon

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FORMULAIRE D’ADHESION
Mme, Mlle, M.
Nom, Prénom : …………………………………………………………………………………………………………………………………….

COORDONNEES
Adresse : ………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………….
Code Postal : …………………………

Ville : ……………………………………………………………………………………..

Téléphone : ………………………………………………………………………………………………………………………………………….
E-mail : …………………………………………………………………………………………………………………………………………………

TYPE COTISATION (à cocher)


Membre : cotisation annuelle 25€ (Chèque à l’ordre d’ARBB)



Membre bienfaiteur : cotisation annuelle 100€


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