ADHERENCE FORM

To be sent with your paiyment to CREDDO
 

I the undersigned :

NAME : .............................................................................
SURNAME : ......................................................................
ADDRESS : .......................................................................
                   .......................................................................
POSTCODE : .....................................................................
CITY : ................................................................................
 

Wish to be member of the
CREDDO society l’Oustau di Petit.

To this effect I join a payment of ________ € (1), which grants me the status of ________ member (1) for the year 2006.

Place ......................................  Date .................................

Signature :
 
 

(1) Benefactor member from 30 €
      Active member 15 €