ASSOCIATION Required information: SURNAME : .................................................................................................. FIRST NAME : .............................................................................................. STREET : ..................................................................................................... POSTAL CODE: ........................................................................................... TOWN : ........................................................................................................ STATE OR PROVINCE : .............................................................................. COUNTRY : ................................................................................................ H-VAN(S) OWNED AND YEAR(S) : ......................................................... Optional information: TELEPHONE (VOICE) : ............................................................................. FAX : ........................................................................................................... MOBILE/CELL : .......................................................................................... E-MAIL : .................................................................................................... 2 TYPES OF MEMBERSHIP :
THE OFFICERS OF THE ASSOCIATION ARE :
GOALS OF THE ASSOCIATION :
Send this form to : Les Amis du Type H, 16 rue du Bel Air, 93700 Drancy, France |