Membership Registration Form
“Au Cri de la Chouette” Association

Last Name: ……………………………………………………………………………..

First Name: …………………………………………………………………………

Email Address: …………………………………………………………………

Telephone: …………………………………..

Pay the sum of €10.00 as a membership fee.

This membership fee entitles you to a 5% discount on purchases of €20 or more at
Lire et Flâner
8 Rue de la Suisse Normande, SEGRIE FONTAINE

Please print this page. Once the form is completed, please send it to us, either in person, by mail, or by email.