eeeecee sees e SSeS esseseseSeeeseSese sees eesee sees ee LE CENTRE FORMULAIRE D’ ADHESION MEMBERSHIP APPLICATION OETAIN | TIN CBRONZE UARGENT | SILVER OOR | GOLD OPLATINE | PLATINUM NOM | PRENOM| LAST NAME | FIRST NAME Oo es] oO Ke S@SCCCSSCSSCSSHSRBSSCSHSSSSHSSSHSHSHSSSEHSSHEHHHHEKBHEHSHEHHHHS $ ADRESSE | ADDRESS : e $ VILLE| CITY CODE POSTAL | POSTAL CODE e $ TELEPHONE| PHONE : e § COURRIEL| EMAIL $ SIGNATURE DATE < D > ies! ° MASTERCARD ° CCHEQUE|CHEQUE OCOMPTANT|CASH e ® SOUHAITEZ-VOUS ETRE INFORME PAR? e WOULD YOU LIKE TO BE INFORMED BY? $ GCOURRIEL | EMAIL OPAPIER |LETTRE e 5 SOSHSHSHHSHHHSHSHSHSHHSHSHSHSHSHKSHSSHSHSHSSHSHSHHHSCHHHHSHHSHSHSHSHSHSHSHSHHKHSHSHSHHHSHHHSHSHSHHSHKHSHSHHSHSHSHHSHSHSHSHHHHSHSHHHSHSHSHHSHSHHHHHSTHEHSHHOHSSHHHCHEHELH s a r e SOUHAITEZ-VOUS DEVENIR BENEVOLE POUR LE CENTRE ? § WOULD YOU LIKE TO BECOME A VOLUNTEER AT LE CENTRE? § OOUI| YES ONON|NO e ®° LANGUE DE PREFERENCE| LANGUAGE OF PREFERENCE ® CFRANCAIS|FRENCH OANGLAIS|ENGLISH e e : 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 e@eeesese soe eseeoseseeeeeeeeeoeeeeeeeeeees eee e2ee88 Suiveznous sur: page 22 Follow uson: = f ‘ 4 d