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

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® WOULD YOU LIKE TO BE INFORMED BY?

* OCOURRIEL | EMAIL CIPAPIER |LETTRE

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° SOUHAITEZ-VOUS DEVENIR BENEVOLE POUR LE CENTRE ?

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

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: 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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