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Formulaire d'adhésion

Informations Personnelles

Nom d'utilisateur

* Nom d'utilisateur

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Mot de passe

* Mot de passe

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Strength: Very Weak

Confirmez le mot de passe

* Confirmez le mot de passe

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E-mail

* E-mail

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Confirmez l'e-mail

* Confirmez l'e-mail

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Nom

* Nom

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Prénom

* Prénom

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Sexe

Homme

Femme

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N° CNIE

* N° CNIE

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Numéro Carte Nationale Identité Électronique

Date de naissance

* Date de naissance

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Adresse de résidence habituelle

* Adresse de résidence habituelle

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Téléphone

* Téléphone

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Pays

* Pays

Maroc

Afghanistan

Albania

Algeria

American Samoa

Andorra

Angola

Anguilla

Antarctica

Antigua and Barbuda

Argentina

Armenia

Aruba

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bermuda

Bhutan

Bolivia

Bosnia and Herzegovina

Botswana

Brazil

Brunei

Bulgaria

Burkina Faso

Burundi

Cambodia

Cameroon

Canada

Cape Verde

Cayman Islands

Central African Republic

Chad

Chile

China

Colombia

Comoros

Congo

Costa Rica

Croatia

Cuba

Cyprus

Czech Republic

Denmark

Djibouti

Dominica

Dominican Republic

East Timor

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Ethiopia

Fiji

Finland

France

French Guiana

French Polynesia

Gabon

Gambia

Georgia

Germany

Ghana

Gibraltar

Greece

Greenland

Grenada

Guam

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Honduras

Hong Kong

Hungary

Iceland

India

Indonesia

Iran

Iraq

Ireland

Israel

Italy

Jamaica

Japan

Jordan

Kazakhstan

Kenya

Kiribati

North Korea

South Korea

Kuwait

Kyrgyzstan

Laos

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Macedonia

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Mauritania

Mauritius

Mexico

Micronesia

Moldova

Monaco

Mongolia

Montenegro

Montserrat

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

New Zealand

Nicaragua

Niger

Nigeria

Norway

Northern Mariana Islands

Oman

Pakistan

Palau

Palestine

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Poland

Portugal

Puerto Rico

Qatar

Romania

Russia

Rwanda

Saint Kitts and Nevis

Saint Lucia

Saint Vincent and the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia and Montenegro

Seychelles

Sierra Leone

Singapore

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

Spain

Sri Lanka

Sudan

Suriname

Swaziland

Sweden

Switzerland

Syria

Taiwan

Tajikistan

Tanzania

Thailand

Togo

Tonga

Trinidad and Tobago

Tunisia

Turkey

Turkmenistan

Tuvalu

Uganda

Ukraine

United Arab Emirates

United Kingdom

United States

Uruguay

Uzbekistan

Vanuatu

Vatican City

Venezuela

Vietnam

Virgin Islands, British

Virgin Islands, U.S.

Yemen

Zambia

Zimbabwe

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Appartenance à d’autres associations ou organisations autorisees

Non

Oui

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Si oui, merci de les renseigner

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Loisirs

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Copie CNIE

* Copie CNIE

Joindre une copie recto/verso.

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Photo d'identité

* Photo d'identité

Joindre une photo d'identité

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Motivations

Comment avez-vous connu l'association?

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Avez-vous de l'expérience dans le domaine associatif? Si oui, décrivez un peu votre expérience

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Quelle est votre disponibilité et le temps que vous pouvez offrir à l'association?

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Quelle est votre fréquence de connexion à Internet en général et au groupe de l’association en particulier ?

Fréquemment (chaque jour)

Souvent (3 fois/semaine)

Rarement (1 fois/mois)

Jamais

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Dans quel(s) pôle(s) souhaiteriez-vous adhérer ?

Pôle Éducation et Culture

Pôle Social

Pôle Communication & Sponsoring

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Réservé aux anciens membres :

Impressions, critiques et suggestions concernant votre expérience à l'association

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Je certifie la conformité des informations ci-dessus.

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Je certifie avoir lu et accepté le règlement intérieur et le statut de l’association.

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Je demande mon adhésion au sein de l’Association

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Votre adhésion ne prendra effet qu’après avoir remis la demande d’adhésion, payé les droits d’inscription à l’association et fourni une copie de votre CNIE.

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