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Formulaire d'inscription au congrès de l'APSV
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* Indicates required question
Email
*
Your email
ETAT CIVIL
Nom
*
Your answer
Prénom
*
Your answer
Date de naissance
*
MM
/
DD
/
YYYY
Lieu de naissance
*
Your answer
Spécialité
*
Your answer
Médecin aéro
*
oui
non
Required
ADRESSE PROFESSIONNELLE
Adresse
Your answer
Code postal
Your answer
Ville
Your answer
Téléphone professionnel
Your answer
ADRESSE PRIVÉE
Adresse
*
Your answer
Code postal
*
Your answer
Ville
*
Your answer
Téléphone portable
*
Your answer
Mail
*
Your answer
EXPÉRIENCE AÉRONAUTIQUE
Heure de vols planeur
*
Your answer
Club planeur
Your answer
Heure de vols avion
Your answer
Heure de vols ULM
Your answer
Instructeur
oui
non
TARIFICATION
335 € pour le congressiste
130 € pour son accompagnant
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