INSCRIPTION AGA 2017 | Registration Form 2017 AGM
7 avril 2018 à 8h30 ---- Caffè della Pace, 1002 Avenue Van Horne, Outremont, PQ H2V 1J5 ---- April 7, 2018 at 830 am
NOM | Family Name *
Your answer
PRÉNOM | First Name *
Your answer
ADRESSE CIVIQUE | Street Address *
Your answer
VILLE | City *
Your answer
CODE POSTAL | Postal Code *
Your answer
COURRIEL | Email *
Your answer
CELLULAIRE | Cell *
Your answer
RÉGION ADMINISTRATIVE | REGION IN QUÉBEC *
Choisir
AFFILIATION (ORGANISME, ENTREPRISE, ETC.) | Doula Group Affiliation *
Your answer
ÊTES-VOUS UN MEMBRE DE L'AQAN? | Membership status *
Des frais de 10 $ par personne non-membre seront facturés pour participer à l'assemblée générale annuelle. | A $10 fee to non-AQAN members to attend the AGM.
Required
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