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Solicitud socio ASPHER
Asociación Asociación de Pacientes de Enfermedades Hematológicas Raras de Aragón
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Correo electrónico
*
Your answer
Nombre
*
Your answer
Apellidos
*
Your answer
Fecha de nacimiento
MM
/
DD
/
YYYY
DNI
*
Your answer
Dirección
*
Your answer
Codigo Postal
*
Your answer
Localidad
*
Your answer
Provincia
*
Your answer
Teléfono fijo
Your answer
Teléfono móvil
Your answer
Cuota de socio
*
Quiero ser socio de ASPHER Aragón pagando la cantidad mínima anual de 24 euros
Quiero ser socio de ASPHER Aragón pagando una cuota periodica
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