Spett. RETE DI AMICIZIA CON LE RAGAZZE E I RAGAZZI DI STRADA - AMISTRADA ONLUS

Je sousignι ....................    .....................

demand d'κtre inscrit comme sympathizant d'Amistrada

Lieu .......................... 

Date ..............

Signature ...................................

 

Nom                       ………………………………

Prιnom                    ..……………………………..

Age                          ..…  

Sexe                       …………….

Activitι                   …………………………

Adresse                rue………………….n. civique………..cap…..ville……………..nation………..

Tel., cell., e-mail   tel……………………cell……………………e-mail………………………..

Motivations pour l’inscription

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Personnes connues dans le rιseau

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