I ask to join the association "Guix Europe" and declare adhering to the
Statutes and the Interior Reglementary of which I have obtained a copy.

Name:

First name:

Birth date (optional):

If no birth date is given: I certify being at least 18 years old.
yes / no

Postal address (optional):

E-mail address:

OpenPGP key finger print (if applicable):

Motivation to join the association:

I am paying the membership fees of 10€:
in cash / by wire transfer / by French check

I agree that my membership status and contact details may be communicated
to other members:
yes / no

I agree that my membership status may be communicated to the general public:
yes / no


Date

Place

Signature