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LE CENTRE

FORMULAIRE D’ ADHESION
MEMBERSHIP APPLICATION

OETAIN | TIN CBRONZE UARGENT | SILVER
OOR | GOLD OPLATINE | PLATINUM

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$ TELEPHONE| PHONE
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§ COURRIEL| EMAIL

$ SIGNATURE DATE

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° MASTERCARD

° CCHEQUE|CHEQUE OCOMPTANT|CASH
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® SOUHAITEZ-VOUS ETRE INFORME PAR?

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$ GCOURRIEL | EMAIL OPAPIER |LETTRE

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§ WOULD YOU LIKE TO BECOME A VOLUNTEER AT LE CENTRE?
§ OOUI| YES ONON|NO

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®° LANGUE DE PREFERENCE| LANGUAGE OF PREFERENCE
® CFRANCAIS|FRENCH OANGLAIS|ENGLISH

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: Le Centre culturel francophone de Vancouver

e 1551 W 7th Avenue, Vancouver, Colombie-Britannique V6J 1S1

: T: 604.736.9806 | F: 604.736.4661

: info@lecentreculturel.com * www.lecentreculturel.com

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