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Adhésion Vélo Club Orbe
Coordonnées nouveau membre
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Email
*
Your email
Genre
*
Femme
Homme
Required
Nom
*
Your answer
Prénom
*
Your answer
Date de naissance
*
MM
/
DD
/
YYYY
Adresse
*
Your answer
NPA
*
Your answer
Lieu
*
Your answer
Pays
*
Your answer
Numéro de téléphone
*
Exemple: +41 79 888 88 88
Your answer
Adresse e-mail
*
Your answer
N°de licence
Your answer
Pratique(s)
*
Ecole de vélo
MTB Cross Country
Vélo de route
Vélo de piste
Cyclocross
E-Bike
Non pratiquant
Required
Statut de membre
*
Membre actif (cotisation 65.- CHF par année)
Ecole de vélo (cotisation 100.- CHF par année)
Commentaires
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