Please print this page and return it to us at the
following address :
Association
Amitié Strasbourg-Japon – 3 quai Kléber – « Le Sébastopol » - 67000
STRASBOURG
Date
: ............................................
Mr, Mrs,
Ms :
Surname
: .............................................................
First
name : ...........................................................
Address
: ...............................................................
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................................................................................
Phone
: ..................................................................
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Fax
: .......................................................................
E-mail :
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would
like to join the Association Amitié Strasbourg – Japon (*)
(__) household (single person or family)
(__) student household (single person or family)
(__) benefactor
and
pay the membership fee (*)
(__) by cheque drawn on a bank account
or
(__) by cheque drawn on a post office account made out to the « Association
Amitié Strasbourg – Japon »
(__) in cash
(*) 8,- € per student household (single person
or family), 20,- € for every other household (single person or family), no
limit for benefactors.