"Vin d'honneur" application

Raider weight:

(* mandatory fields)

Association *

Representative *

Address of correspondance *

Date *

Month

Day

Year

Telephone number *

E-mail address *

Motif *

Location *

Number of participants *

Time of the reception *

Hour

Minute

Remarks *

I allow the use of my personal data in the context of this request *

Yes

Math question * 2 + 1 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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