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Formulaire d'adhésion
Informations Personnelles
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Nom d'utilisateur
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Mot de passe
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    Strength: Very Weak
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    Confirmez le mot de passe
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    E-mail
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    Confirmez l'e-mail
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    Nom
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    Prénom
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    *
    Sexe
    HommeFemme
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    N° CNIE
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    Numéro Carte Nationale Identité Électronique
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    Date de naissance
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    Adresse de résidence habituelle
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    Téléphone
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    Pays
    MarocAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe
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    Appartenance à d’autres associations ou organisations autorisees
    NonOui
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    Si oui, merci de les renseigner
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    Loisirs
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    *
    Copie CNIE
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    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 CulturePôle SocialPôle 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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