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Adhesion Form

Hello and welcome.
To become a member of the association freeGuppY, please fill in the form below.
Cheerfully! The association freeGuppY

Boxes with * are compulsory
I'd like to become a member of freeGuppY, the association users of the script "GuppY", governed by the 1901 French law on non-profit associations, whose aim it is to ensure the promotion and durability of the "GuppY" software and its values :
I am * :
Title * :
      
Logo (companies only):
Surname * :
First name * :
Postal Address 1 * :
Postal Address 2 :
Postcode * :
Town * :
Country: * :
Email * :
Login :
Telephone :
Fax :
Mobile :
ICQ, MSN, ... :
(specify):
Occupation :
Date of Birth :
       I authorize the use of my name and/or my image for communication purpose by freeGuppY exclusively * :
    
I would like to become a member of the management committee of freeGuppy * :
    
     I would like to be involved the life of the association * :
    
As (If button yes is ticked) :
Website (whole URL, 3 max) :
Remarks, suggestions, questions :
 
copy the code :

Signature : The reception of your subscription fee stands for your signature and validates your subscription