[ Galette ]

Subscription

AES : Association d'entraide et de solidarité

NB : The mandatory fields are in red

Identity:

(mm/dd/yyyy format)

Contact information:


Galette-related data:

(at least 2 characters)

Password image Please repeat in the field the password shown in the image.


Additionnal fields:

(mm/dd/yyyy format)

Conjoint (not translated)

(mm/dd/yyyy format)

Enfant mineurs (not translated)
1er enfant (not translated)

(mm/dd/yyyy format)

2eme enfant (not translated)

(mm/dd/yyyy format)

3em enfant (not translated)

(mm/dd/yyyy format)

4em enfant (not translated)

(mm/dd/yyyy format)

5 eme enfant (not translated)

(mm/dd/yyyy format)

fiche adhesion (not translated)
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