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Membership form, in HTML

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freeGupp Y
A non-profit-making association (1901 law)
                                                           
You have been wishing to make a donation to the freeGuppY association.
The procedures are quite simple :
  • Carefully fill-in a printout of this donation form. The details are required for the editing of your tax- receipt.
  • Please make your cheque payable to the association freeGuppY. You can also pay your dues by clicking on the icon Paypal.
  • Then post it in a properly stamped envelope to the treasurer of the association :
Monsieur Yves LE BORGNE
Tresorier de l'association freeGuppY
22 rue du Tregor,
29490 Guipavas,
France


See you soon,
Associative greetings,

The president of freeGuppy


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freeGupp Y
Association loi 1901 à but non lucratif

MEMBERSHIP FORM


Vous pouvez aussi adhérer en ligne, en cliquant ci-dessous :


Adhésion en ligne



[¯] I wish to become a member of freeGuppY, the association of users of the "GuppY" script , defined by the French law of July 1st 1901, which aims at promoting and maintaining the software "GuppY" and its values :

[¯] Company: 45 €, [¯] Association: 30 €, [¯] Private : 15 €

Subscription for one year (12 months).
Enclosed Cheque, payable to the association freeGuppY.
You can also pay your dues by clicking on the icon Paypal.

In agreement with the Internet Freedom and Information laws about data protection issues, the privacy of personal information and their exclusive use for the association purposes are guaranteed. You always retain control of your information with freeGuppY


     Title* : [¯] Mr,          [¯] Mrs,                 [¯] Ms,
                [¯] Firm,       [¯] Ldt Company,   [¯] Association, 
                [¯] other (specify)     ......................................

     Legal Form* :  [¯] Private,  [¯] Company,  [¯] Association,
     Company name*:  ......................................

     Surname*:   ......................................
     First name*:     ......................................
     Postal Address 1*:     ......................................
     Postal Address 2 :     ......................................
     Postal Code* :     ......................................
     Town*:     ......................................
     Country*:     ......................................

     E-mail*:     ......................................
     Username*:     ......................................

Telephone :      ......................................
Fax :      ......................................
Mobile :      ......................................
[¯] ICQ, [¯] MSN, [¯] other : .      ......................................
Occupation:      ......................................
Birthday :     ......................................


     [¯] I give permission,
     [¯] I don't give permission
for my name or my image to be used for purposes of communication solely by freeGuppY.*

You may enclose if you wish [¯] a passport photo, or [¯] a logo for legal entities.


or my name or my image to be used for purposes of communication solely by freeGuppY.*

[¯]  I wish to be involved the life of the association as :
 ............................................................................
............................................................................


Website : ............................................................................
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............................................................................ 
............................................................................


Remarks , suggestions , questions :
............................................................................
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............................................................................
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Made in ...................................... on ......................................


Signature * (and stamp for moral entities) :  ......................................
  *=compulsory fields

Creation date : 12/06/2007 @ 05:03
Last update : 31/12/2012 @ 10:23
Category : Participation Promotion - Help freeGuppY
Page read 58094 times