Membership

Mr.Mrs.Miss…………………………………………………………………………………

Address : ………………………………………………………………………………………………………………

Postal code ……………… City ……………………………………………………………….

Telephone number  ……………………………………. Profession ………………………………………

E-mail ………………………………………………………………………

Adheres to the association "Vélocypède" for one year from:

O simple: €15,         O donation:     €

O cash,  O cheque, O postal order

Date …………………………………………………………

Signature:

 

Send membership and payment to:

                                                            

Association  «Vélocypède » 

8, impasse des Roitelets 

Village de Kervam

56270 PLOEMEUR FRANCE

Tél. : 07.82.66.47.11

Mail : This email address is being protected from spambots. You need JavaScript enabled to view it.

Site internet : www.jeunecyclo.fr

 

 

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