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Bulletin d’Adhésion de l'Association ITEM
(A conserver par l’Association)
Je soussigné(e) :
né(e) le :
téléphone : email :
adresse :
déclare solliciter mon adhésion en tant que Membre Usager à l’Association ITEM,
75 BD Charles Livon 13007 Marseille ; pour la période du 07/09/2013 au 31/12/2014.
Je déclare avoir reçu un exemplaire des statuts du règlement intérieur de
l’association, dont j’ai pu prendre connaissance. Je déclare m’engager à respecter
toutes les obligations des membres de l’association qui y figurent. Je déclare avoir
été également informé des dispositions de la loi du 6 janvier 1978 qui réglemente le
droit de communication dans le fichier des membres de l’association des données
personnelles me concernant.
Fait et signé le , à
Bulletin d’Adhésion de l'Association ITEM
(A conserver par l’Adhérent)
Je soussigné(e) :
né(e) le :
téléphone : email :
adresse :
joint à la présente demande d’adhésion en tant que Membre Usager à l’Association
ITEM, 75 BD Charles Livon 13007 Marseille ;
pour la période du 07/09/2013 au 31/12/2014 ;
le paiement de la somme de 10,00 € payée en la forme suivante :
Fait et signé le , à
Reçu de la somme de 10,00 € le
Association ITEM
Le Président,
Francesco Waihrich

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Bulletin Adhésion - Membre Usager - Association ITEM

  • 1. Bulletin d’Adhésion de l'Association ITEM (A conserver par l’Association) Je soussigné(e) : né(e) le : téléphone : email : adresse : déclare solliciter mon adhésion en tant que Membre Usager à l’Association ITEM, 75 BD Charles Livon 13007 Marseille ; pour la période du 07/09/2013 au 31/12/2014. Je déclare avoir reçu un exemplaire des statuts du règlement intérieur de l’association, dont j’ai pu prendre connaissance. Je déclare m’engager à respecter toutes les obligations des membres de l’association qui y figurent. Je déclare avoir été également informé des dispositions de la loi du 6 janvier 1978 qui réglemente le droit de communication dans le fichier des membres de l’association des données personnelles me concernant. Fait et signé le , à Bulletin d’Adhésion de l'Association ITEM (A conserver par l’Adhérent) Je soussigné(e) : né(e) le : téléphone : email : adresse : joint à la présente demande d’adhésion en tant que Membre Usager à l’Association ITEM, 75 BD Charles Livon 13007 Marseille ; pour la période du 07/09/2013 au 31/12/2014 ; le paiement de la somme de 10,00 € payée en la forme suivante : Fait et signé le , à Reçu de la somme de 10,00 € le Association ITEM Le Président, Francesco Waihrich