fondée en 1954 sous le n^° 57623 - Enregistrement n^° 76.541.

________________________________________________________________________________________

I, undersigned Name ………………………fore-name .........………..

born the ……………….

trade …………………………

Address …………………………………………………………..

…………………………………………………………..

phone ……………….. e.mail ………………..

require to join the "Association Vitolphilique et Philuménique Française"

in the Section :

Vitolphilie-Cigar rings (28 Euros) , Philuménie- match boxes (28 Euros) , Cigar and match boxes (40 Euros) from the 1st of Januar 2016 (*)

I join a cheque for my contribution

:total .......Euros

 Date and signature:

(*) The new adherent receives all the publications from the 1st of january of the adhesion year. If you join us after the 1st of september,it's important to specify if your adhesion is effective at the prévious 1st of january or from the next year

……………………………………………………………………………………………………………

Informations you will make appear in the directory of the association: :

(These informations could be modified instantly by mail at the treasurer)

Name and Fore-name .................................................................

 Adresse .................................................................................................................

Tel................................. e-mail ................

1° fields collected (cigar rings or match boxes)

 2° Other collections and interest centers

……………………………………………………………………………………………………………………… 

This bulletin of adhesion is to send to:

M. Philippe ROBERT 15 rue de Kersalic 22200 GUINGAMPFRANCE

with a cheque worded in the name of:

AVPF - CCP. 20.152.20 M - PARIS :

(BIC) PSSTFRPPPAR

(IBAN) FR92 2004 1000 0120 1522 0M02 083