Demande d’adhésion / Membership form
Remplissez ce formulaire pour devenir membre de la Coalition de la Petite-Bourgogne. / Fill out this form to become a member of the Little Burgundy Coalition.
Nom / Last name *
Your answer
Prénom / First name *
Your answer
Nom de l'organisme (si applicable) / Name of organization (if applicable)
Your answer
Adresse / Address *
Your answer
Ville / City *
Your answer
Province *
Your answer
Code postal / Postal code *
Your answer
Téléphone / Phone number *
Your answer
Courriel / Email *
Your answer
Meilleur moyen pour vous joindre / Preferred method of communication *
LANGUE / LANGUAGE *
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