BLUES etc… Membership

To become a member of BLUES etc… , print this page and address it to:

REQUEST to become a BLUES etc... Member
Type of member
I wish to adhere to BLUES etc as a member actif 23€ benefactor 50€ donor unlimited
Postal adress of Member
NAME :	.....................................................................................................................................
GIVEN NAME :	.....................................................................................................................................
ADRESS :	.....................................................................................................................................
POSTAL CODE :	.....................................................................................................................................
TOWN :	.....................................................................................................................................
COUNTRY :	.....................................................................................................................................
Phone :	........................................................................................
E-mail :	........................................................................................

Chèque		Please herewith find has check off year amount off ........ Euros payable to BLUES etc...
Virement		Off ..... Euros one the account of BLUES etc... whose references banquaires are as follows:
		IBAN : FR76 1820 6000 6656 2561 2900 191 BIC : AGRIFRPP882
		My subscription will be recorded after payment by my bank of the corresponding amount. Confirmations by mails of the payments by the banks are to be sent to

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