Form to print

                                                              Adhesion response

Name:.................................................................. First name:........................... Business....................................................................... Address:.....................................................................................................................................................................

Postal code:..............City:..................................... Country:.............. Tel:...................................................E-mail address :..........................................

 Want to be a member of SENAMI Association and pay a 25 euros annually contribution.

Eventual gift:.............................€

Date :  ...........................

Signature: 

                           Send this form with your money contribution to :

Association SENAMI, 2 Allée Jean Roy- 37000 TOURS.