Honorific Committee


To become a member of the HONORIFIC COMMITTEE :

Fill this form and then click on "Validate" below
or print sign and send this form by fax or postal mail to : :

OPTIMISTIC MOVEMENT, 55 rue Victor Hugo, 78800 Houilles, France
Fax : + 33 1 30 86 00 10 - E-mail : [email protected]

 

First name and NAME*

Ex : John SMITH

Address*


Ex : 3 Bear Valley Road

Zip code and city*

Ex : San Diego CA 92103

Country*

(choose in the list)

Telephone*

Ex : +331 3086 00 33

Fax

Ex : +331 3086 00 10

Profession*

Ex : computer analyst

Age*

years

E-mail*

Ex : [email protected]

Message :

 

 

(* = required zone)

Ex : I am bilingual french/english

I consider the objectives of the OPTIMISTIC MOVEMENT as respectable
and I accept to become a member of the HONORIFIC COMMITTEE.

Your application will be submitted to the approval of the Board of Directors in its next meeting.