SCSOHOSSHSSSSOHSHSSHESSSSESHSHSHSEHHCHEHSSCHOEHOEEOSESEEEEEE

LE CENTRE

FORMULAIRE D’ ADHESION
MEMBERSHIP APPLICATION

OETAIN | TIN UBRONZE OU ARGENT | SILVER
OR | GOLD UOPLATINE | PLATINUM

NOM | PRENOM | LAST NAME | FIRST NAME

Q
Le 5]
Q
=

ADRESSE | ADDRESS

VILLE | CITY CODE POSTAL | POSTAL CODE

TELEPHONE | PHONE

COURRIEL| EMAIL

SIGNATURE

:

VISA

5

MASTERCARD
CCHEQUE|CHEQUE UCOMPTANT|CASH

5

SSSHSHHSHSHSHSHHSHSHSHSHHSHSHSHSHSHHHSHSHSHSHSHHSHSHSHHSHSHSHSHHSHHSHHSHSHSHHHSHSHHHHHHHHHHHHSHHOHSHSHHHOHSHSHSHOHSHESOOEEE
SSSHSHSHHSHSHSHHSHSHHSHFSHSHHHHSHHSHSHHSHSHSHSHHSHSHHSHHHHSHHHSHHHSHSHHSHSHHSHHOHHSHSHSHHSHSHSHHHHSHOHHOHHHSHHSHHOHSHHHHHHOHSHSHSHSHHOHOHSOSHSHEHHOSOOHLEES

S SOUHAITEZ-VOUS ETRE INFORME PAR?

® WOULD YOU LIKE TO BE INFORMED BY?

* OCOURRIEL | EMAIL CIPAPIER |LETTRE

e

° SOUHAITEZ-VOUS DEVENIR BENEVOLE POUR LE CENTRE ?

® WOULD YOU LIKE TO BECOME A VOLUNTEER AT LE CENTRE?
e DOUI|YES DNON|NO

e

e

se

e

e

: Pea

: Le Centre culturel francophone de V

e 1551 7iéme Avenue Ouest, Vancouver, Colon

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e T: 604.736.9806 | F: 604.7

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

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