Association Amitié Strasbourg - Japon

 

 

 

Please print this page and return it to us at the following address :

Association Amitié Strasbourg-Japon – 3 quai Kléber – « Le Sébastopol » - 67000 STRASBOURG

 

 

 

Membership 2016

 

 

Date : ............................................

 

 

Mr, Mrs, Ms :

 

Surname : ............................................................

 

First name : ..........................................................

 

Address : ..............................................................

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Phone : .................................................................

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Fax : ......................................................................

 

E-mail : .................................................................

 

 

 

would like to join the Association Amitié Strasbourg – Japon (*)

 

O    household (single person or family)

O    student household (single person or family)

O    benefactor

 

and pay the membership fee (*)

 

O    by cheque drawn on a bank account and made out to the « Association Amitié Strasbourg – Japon »

 

O    in cash

 

 

 

(*)     25,- € per household (single person or family), free for student households, no limit for benefactors.