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Feuil1

------=_NextPart_01CB2840.0DC3B9E0 Content-Location: file:///C:/451244D9/Bulletin_inscription_nancy_fichiers/sheet001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"

ASSOCIATION TERVILLOISE D'EDUCATION MUSICALE

<= /td>

Site : www.atemecole.com

<= /td>

BULLETIN D'INSCRIPTION 2010/2011

No= m, Prénom

____________________________________________= ____________________________

Da= te de naissance

____________________________________________= __________________________

Re= sponsable

____________________________________________= _______________________________

Adresse

____________________________________________= ____________________________

Code postal

_______________

Ville

_________________________________________

T&= eacute;l. domicile

_______________

Tél. portable/bureau

______________________________

Ad= resse mail

____________________________________________= __________________________

<= /td>

Formation musicale

Cours

Professeur

Jour

Horaire

Formation instrumentale / Vocale

Instrume= nt

Professeur

Jour

Horaire

<= /td>

<= /td>

<= /td>

Formation collective (gratuite)

Atelier(s) conerné(s )*

Professeur

Jour

Horaire

<= /td>

<= /td>

Montant

Obse= rvation (mode de paiement)

Carte adhési<= span style=3D'display:none'>on*

Adh&= eacute;sion SE

Cotisati= on 1

Cotisati= on 2

TOTAL

Sept Oct Nov Déc Janv Fév Mars Avril Mai Juin

*c= otisations obligatoires : &nbs= p; - adhérent à une association, loi 1908

- convention signée avec la SEAM Paris

(sauf guitare d'accompagnement, harmonica, basse, djembé, éveil et jardin musical)

=

J'autori= se l'ATEM à utiliser des prises de vue (photos, vidéo, site internet…) de mon (mes) enfant(s) réalisées lors des<= /td>

activit&= eacute;s à des fins promotionnelles et publicitaires : OU= I □ &nbs= p; NON □

<= /td>

Monsieur / Madame __________________déclare(nt) avoir pris connaissance du règlement intérieur, en particulier

des dispositions qui ont trait au règlement immédiat des cotisations pour valider toute inscription et concernant

&e= acute;galement le remboursement des adhérents en cas d'interruption prématurée des cours.

(l= ongue maladie, déménagement).

Fait à Terville, le_______________________________

<= /td>

Signature

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