Formulaire d’inscription<\/b>
Vous pouvez imprimer cette page et l’envoyer accompagn\u00e9e d’un ch\u00e8que de 10 \u20ac \u00e0 l’adresse suivante :<\/p>\n
M\u00e9ningites France-Association Audrey,<\/b><\/p>\n
<\/b><\/p>\n
31, mail des Quatre Vents<\/p>\n
49 000 Ecouflant<\/p>\n<\/b>
<\/b><\/p>\n
FRANCE<\/b><\/p>\n
BULLETIN D’ADHESION renouvelable tous les ans en janvier.<\/p>\n
Nom :_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _<\/p>\n
Pr\u00e9nom : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _<\/p>\n
Adresse : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _<\/p>\n
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _<\/p>\n
Code Postal : _ _ _ _ _ _ _ _ _ _ _ _ _ _Ville : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _<\/p>\n
T\u00e9l\u00e9phone : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _<\/p>\n
E.mail:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _<\/p>\n
Adh\u00e9sion : 10 \u20ac<\/b><\/p>\n
Je joins mon r\u00e8glement \u00e0 l’ordre de M\u00e9ningites France-Association \u00ab\u00a0Audrey\u00a0\u00bb<\/p>\n
V<\/b> par CCP<\/p>\n
V<\/b> par Ch\u00e8que bancaire<\/p>\n
V<\/b> par Esp\u00e8ces<\/p>\n
Je souhaite \u00e9galement verser \u00e0 M\u00e9ningites France-Association \u00ab\u00a0Audrey\u00a0\u00bb, \u00e0 titre de don, la somme de :<\/p>\n
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _<\/p>\n
Date : Signature :<\/p>\n
V<\/b> Je souhaite recevoir un re\u00e7u correspondant \u00e0 la somme vers\u00e9e<\/p>","protected":false},"excerpt":{"rendered":"
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