AAEN - Formulário de adesão

Para tornar-se sócio da "Associação dos Ambientalistas a favor da Energia Nuclear",
favor preencher, imprimir e enviar este formulário ao seguinte endereço :

Associação dos Ambientalistas a favor da Energia Nuclear
55 rue Victor Hugo, 78800 Houilles, France
Telefone: +33 1 30 86 00 33 - Fax: +339 552 900 22 ; E-mail: po[at]ecolo.org (spam prevention: replace [at] by @)

 

Sobrenome* :

Nome* :

Endereço* :

Codigo postal* :

Cidade* :

Pais* :

E-mail* :

Telefone :

Fax :

Profissao :

Idade :

anos

(*) Zona requerida

ADESÃO : SIM, solicito a minha inscrição como sócio da Associação dos Ambientalistas a favor da Energia Nuclear na qualidade de :

  Sócio Suportando : Eu aprovo sua ação (gratuito, emita a AAEN pelo fax)
   Sócio Simpatizante: 25 Euros por um ano
  Sócio Ativo:  50 Euros por um ano
  Sócio Benfeitor: 100 Euros por um ano

Membro Simpatizante, Ativo o Benfeitor receberá um recibo pelo correio tradicional. Os membros novos são sujeitos ao acceptation pela diretores de AAEN. Você será informado pela lista e-enviando de AAEN.

SIM, eu concordo ser um correspondente local de AAEN na seguinte area :
Donation adicional para suportar a Associação : Euros

Pagamento incluido : EUROS em :
cartão de crédito cheque ordem bancária
a favor de : Ambientalistas a favor da Energia Nuclear

 

Data : Assinatura :  

 

 FIRST STEP : fill out, print and send this page to EFN

After completing this form, select your printer (or PDF format) and click on the "Print" button to print this page. You can also use the "Print" button in the menu of your navigating software. 

This page can be printed either : 1/ on paper, in this case, fax the paper-printed form to +33 9 55 29 00 22 or 2/ to a PDF file (using ACROBAT WRITER or a similar software), in this case send the PDF file to po[at]ecolo.org (spam prevention: replace [at] by @).

Sign the printed paper version if you print this page on paper and send it to EFN by fax, or type your name or any alpha-numerical code legally representing your signature, for example : /Marco DaCosta/ or /madacosta8492xfp8902/ into the "signature" zone, if this page is printed to a PDF file and sent to EFN by e-mail.

 

SECOND STEP : send your payment to EFN by one of the three following methods

Payment by credit card: note the amount of your membership (indicated above), click on the visa card logo below (choose your currency), type the amount of your membership in the appropriate box and follow the instructions. Most credit cards are accepted (Visa, Mastercard, American Express...). The amount of your payment will be debited from your credit card account. The transmission of your credit card number is securized by https protocol.

click : for payment by credit card in Euros (EUR)

 

Payment by wire transfer (in Euros): send an e-mail to po[at]ecolo.org (spam prevention: replace [at] by @) asking for instructions concerning payment by electronic wire transfer. You will receive instructions by e-mail.

Payment by cheque (in Euros): send this membership registration form printed on paper by traditional mail with your cheque to : Environmentalists For Nuclear Energy, 55 rue Victor Hugo, 78800 Houilles, France. Cheques are to be denominated in EUROS and to be drawn on a French bank. If your bank is not in France, ask your banker to prepare a cheque drawn on a French bank. Eurocheques are not accepted.

According to the law, you have the right to access and correct the computerized information which concerns you.