Association affiliιe ΰ l’UNOR

 

DEMANDE D’ADHESION

 

Nom                             : ………………………………………………………………………….

Prιnom             : ………………………………………………………………………….

Date de naissance         : ………………………………………………………………………….

Lieu de naissance          : ………………………………………………………………………….

Etat civil                       : ………………………………………………………………………….

Adresse personnelle      : Rue……………………………………………………………………...

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Profession                     :…………………………………………………………………………..

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Grade                           : ………………………………………………………………………….

                                    Terre o            Air o               Mer o              Gend. o

                                    Rιserve affectι o        Rιserve non affectι o Honoraire o     Autre o

Arme                            : ………………………………………………………………………….

Durιe du service           : ………………………………………………………………………….

Dιcorations                  : ………………………………………………………………………….

¨       SMV                      o ………………………………………………………………………..

¨       ONM                     o ………………………………………………………………………..

¨       Lιgion d’Honneur   o ……………………………………………………………………….

¨       Autres                    o ………………………………………………………………………..

 

A retourner ΰ :

* Chef D’Escadron (R) Monnoire Patrick 389 chemin des Galas 01170 GEX

e-mail : aorsl@free.fr, site web : http://aorsl.free.fr

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