MEMBERSHIP FORM L’ALLIANCE FRANÇAISE D’EL PASO (AFEP)

2012
Renouvellement Nouveau Membre
 Individuel Famille

 (Renewal)
(New Member)
(Single)
(Family)

(Cochez la case correspondente; check the correct box)

Nom (Last name):________________________________Prénom (First name):________________________________

Nº. rue (Address):_________________________________________________________________________________

Ville (City):_________________________________État (State):_______________Code postale (Zip):_____________

Telephone: (_______) __________ - _____________________

E-mail Address: ________________________________________________________________

Month _________________ and Day ______ of your birthday to list in the l’AFEP Petit Francophone (newsletter).

Composition de la famille (family members, if membership is for family)
Prénom (First name)
Date de naissance (Birthdate)
Conjoint (Spouse)

Enfant 1 (Child 1)

Enfant 2 (Child 2)

Enfant 3 (Child 3)


Would you like to become a member of l'Alliance Française? Yes_____ No_____

How did you learn about the classes?__________________________________________________________________

MEMBERSHIP FEE

Student $15
Individual $30
Family $40
Corporate $100
Benefactor
 $150
Life Member $1000

Renewal is due in January
PLEASE MAKE YOUR CHECK PAYABLE TO:

AFEP

and send to:

AFEP c/o Maud Snell, 809 Claravista Ln, El Paso, TX 79912

Write your telephone number on your check to be mailed with the enrollment form.

For more information
call Maud Snell, vice-president, at (915) 833-8705



Signature: _____________________________________________________

YOUR MEMBERSHIP IS SINCERELY APPRECIATED!
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