To become a member, print this form, and after having filled it,
send it with your cheque to:
Association Athina Ichtyose Monaco (AAIM)
P.O.Box 141
98003 MONACO Cedex
MEMBERSHIP FORM
I undersigned, □ Miss,
□ Madam, □
Mister
Name and First names:..............................................................
Postal Address :
.......................................................................
................................................................................................
Email Address :
..............................@.....................................
Telephone :
.............................................................................
Fax :
.......................................................................................
Give my support to the AAIM by addressing my annual contribution
(personal bulletin).
15 euros or more : ..........................euros
AAIM has for goal to make known the ichtyosis so that another glance is
posed on the people suffured it and to develop medical research.
Its accountancy is controlled by the Auditor:
-
Alain LECLERCQ - 2, rue de la Lüjerneta - 98000 MONACO
Fax : 00 377 97 77 77 01
Email : aleclercq@gld-experts.com
Thank you to write the cheque (postal or banking) with the order of:
" Association Athina Ichtyose Monaco" or "AAIM".
A receipt will be addressed to you under fortnight.
Do not hesitate to photocopy this bulletin to make it circulate to
your parents and friends. In advance thank you for your help.
