BULLETIN OF ADHESION

to the International Movement for a Libido Ecology (I.M.L.E. / M.I.E.L.)

logologologo

Individual annual adhesion: 20 € and more

Adhesion with reduced tariff (Students, Unemployed on documented proof): 10 € and more

Benefactor member : 80 € and more

Donation (specify the sum):            €

The members will receive the semi-annual news bulletin and will be convened at the annual general assembly.

Write below your coordinates in capital letters:

Name:   First name:  
Address:  
 
Zip code:   Commune:  
Country:  
E-mail:   Web site (for juridical persons):  
Prof. phone # (optional):   Perso. phone # (optional):  
Portable phone (optional):   Fax (optional):  

Do you accept that your coordinates will be transmitted to the members of your area in order to set up a local group?
Yes - No (stripe the useless mention)

Do you agree to be contacted to carry on a voluntary activity on behalf of the association?
Pedagogical activity - Making contact with the professionals and the institutions - Promoting the association (holding a stand, distributing leaflets...)  (surround the mentions which interest you)

Print and send back this bulletin together with your cheque made payable to M.I.E.L. to the following address:
M.I.E.L.
69, rue Lecourbe
F-75015 Paris
France


The information that you transmit is intended for the exclusive use of the M.I.E.L. In accordance to the French "Data-processing and Freedom" law of January 6, 1978, you have a right to access and to correct your data.