LE CENTRE

- FORMULAIRE D’ADHESION |
_ MEMBERSHIP APPLICATION

Q BRONZE [_] ARGENT | SILVER
QO OR | GOLD [J PLATINE | PLATINUM [J ETAIN | TIN

NOM | PRENOM | LAST NAME | FIRST NAME Orde i
ADRESSE | ADDRESS

mueteny CODE POSTAL | POSTAL CODE
: TELEPHONE | PHONE

? COURRIEL | EMAIL

! SIGNATURE DATE :
? MASTERCARD EP |
§ L) CHEQUE|CHEQUE (_} COMPTANT|CASH

SOUHAITEZ-VOUS DEVENIR BENEVOLE POUR LE CENTRE ?
} WOULD YOU LIKE TO BECOME A VOLUNTEER AT LE CENTRE?

:Q) oulves LL) NoN|No

LANGUE DE PREFERENCE | LANGUAGE OF PREFERENCE
: (L) FRANCAIS FRENCH (L) ANGLAIS|ENGLISH

Sa fae neti ee bare
Le Centre culturel francophone de Vancouver
1551 W 7th Avenue, Vancouver, Colombie-Britannique V6J 1S1
T: 604.736.9806 | F: 604.736.4661
@lecentreculturel.com © www.lecentreculturel.com
cha, 12.32: 2g