The Bordeaux-USA Association is waiting for you !
Come and join us !
MEMBERSHIP FORM
(Academic year 2009/2010)
*Date of registration (valid 1 year) : ..........................*Member # : .........................
(*) : Reserved to the Association. Please do not write anything above.
NAME : .Mr, Mrs, Ms.............................................................................................
First name : ....................................... Address: ..........................................................
...............................................................Zip :.......................City:.............................
Country :............................Date and place of birth : ...............................................
.......................................Citizenship : ........................................................................
Tel : ...................................................Fax : .................................................................
E-mail : ........................................................................................................................
Internet : http://..........................................................................................................
Occupation : ...................................................................Unemployed - Retired
Student (level/courses) : .......................................................................
Students and youth: 25 Euros
Adults : 40 Euros ( 55 per couple)
Businesses, organizations et donors : 100 Euros minimum.
Payment in Euros by : [] check [] international money order
Signature :
Please print this document and send it to :
ASSOCIATION BORDEAUX-USA
38 ALLEES d'ORLEANS , 33000 BORDEAUX
FRANCE
Send check or international money order in Euros along with this form. A membership card will be sent to you.
