------------------------------------------------------------------------------
75116 Paris
Name * ---------------------------------
------------------------------------------------------------------------------
| ------------------------------------------------------------------------------ |
|
| Association A Child, A Promise | |
| 42 bis avenue George
Mandel, 75116 Paris |
|
| Support formula | |
| YES, I wish to support the association | |
| "A Child, A Promise" | |
| I send you a check of : ------------- euros | |
| Company --------------------------------- | |
| Family Name * --------------------------------- Name * --------------------------------- |
|
| Address---------------------------------------------------------- | |
| Postal code ------------ City ------------------------------ | |
| Country: ----------------- | |
| * optional | |
| According to the data processing and freedom laws of the 6th of January 1978, you may have access to any information concerning you and may ask their adjustment or their suppression. | |
| ------------------------------------------------------------------------------ |
|
|