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Application form for members  
 

Please fill out the form and return it 2 weeks before the date of the exam at the latest:
- by e-mail: rajiv.bhardwaj@afindia.org

- to the center:
Alliance Francaise de Chandigarh,
Next to Hibiscus Garden,
sector 36-A,
Chandigarh 160036

Surname   Miss Mrs. Mr.
 
Name  
 
Date of birth day / month / year  
 
Place of birth  
 
Nationality  
 
Residential Address  
 
Telephone Fax  
 
Office Address  
   
Telephone Fax  
     
E-mail  
( Please indicate where you wish to receive your magazine )
 
Registered no.  
     
I hereby certify the accuracy of the above details and acknowledge
the receipt of the rules and regulations of the Alliance françaises de Chandigarh.
     
     
    Signature of member  
       
       
       
    Signature of Director  
       
Proposed by two active members :    
  Name Signature  
1  
2  
       
Receipt No. Date Amount Valid upto
 
 
     

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