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Secretariat of the Association "Les Amis de Pauline Jaricot"

6, avenue Adolphe Max - 69321 LYON CEDEX 05

Phone: 04 78 81 47 76

 

Your membership will be effective upon receipt of the application form below, accompanied by the amount of your membership by check. You will receive in return the nominative membership card for the current calendar year.

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"The Friends of Pauline Jaricot"

YEAR 2020

 

NEWSLETTER MEMBERSHIP

 

 

     I, the undersigned,

 

  • Last name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • First name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • E-mail  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  • Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

  • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

  • phone : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

     request my membership in the association " Les Amis de Pauline Jaricot " in accordance with the social objective and the official statutes accepted by the general assembly on February 5, 2010 and published in the Official Journal under Ref. / W691076196.

 

    The amount of the membership fee is set each year by the general assembly, i.e. 20 € for the current financial year, following the GA of November 30, 2020.

 

     Enclosed, membership fee: amount in words

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

     In accordance with article 6 of the statutes, the association is able to issue, on request, a receipt for any donation made to its advantage for the achievement of its objective.

 

     Enclosed, manual donation : amount in words

 

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The,

Signature

 

 

 

Association law 1901 N ° W691076196

SIRET number 844 061 358 017

Head office: 42, Montée Saint Barthélemy - 69005 LYON

https://www.paulinejaricot.org/