ASSOCIATION POUR LA MEMOIRE DE L’EMIGRATION

ADHESION FORM

N°............

Last name and first name: ...................................................................................................... Address: ................................................................................................................................. Zip Code: ....................................... City: ................................................................................ Country: ......................................... E-mail: ............................................................................ Membership fee (your selection) : Basic: 20 € Benefactor: € 45

Donor: € 60.

I pay my membership fee ....................................... € (*)

❏ by bank transfer (E.U. only) (*) ❏ with PayPal

Order: Association pour la Mémoire de l’Emigration IBAN: FR96 2004 1010 0110 9000 6H02 223 – BIC: PSSTFRPPBOR

Please send by mail your adhesion form to : AME - Jean MASOUNABE - 33 rue de la BIELLE 64680 OGEU - FRANCE

Date: Signature:

adhesion form

I pay my membership fee ....................................... €. ❏ by bank transfer (E.U. only) (*). ❏ with PayPal. (*) Order: Association pour la Mémoire de l'Emigration. IBAN: FR96 2004 1010 0110 9000 6H02 223 – BIC: PSSTFRPPBOR. Please send by mail your adhesion form to : AME - Jean MASOUNABE - 33 rue de la BIELLE.

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