Formulaire d’adhésion individuelle

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Formule choisie

Section de rattachement

Rattachement au Groupe Adhésifs

Nom

Prénom

Niveau d'études

E-mail

Fonction dans la société

Métier

Ecole/Université

Nom de la société

Nom de la société d'origine

Spécialité

Domaine d'activité

Domaine d'activité d'intérêt

Secteur

Adresse postale

Ville

Code postal

Téléphone

Profil linkedin

Tarif (adhésion valable du 1er janvier au 31 août de l'année en cours)

Type de paiement

Je ne souhaite pas que l'AFTPVA publie mes coordonnées dans l'annuaire des adhérents.