Welcome » Benefactor

Benefactor

I would like to show solidarity with the actions carried out by the Association by contributing financially.
I pay the amount of my choice by transfer or check payable to “L’ASPIC”

Price:

First Name:* First Name Required

Last Name:* Last Name Required

Address1: Address 1 is not valid

Line 2 address: Address line 2 is not valid

City: City is not valid

Country: Country is not valid

State/Province: State/Province is not valid

Postal/ZIP code: Postal/ZIP code is not valid

Phone:* Telephone is Required

Date of birth: Date of birth is not valid

Occupation:* Profession is Required

How did I find out about the Association?:* How did I find out about the Association? is Required

Membership type:* Membership Type is Required

E-mail:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

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Coupon Code:

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Description	Amount
Benefactor – Payment	100.00€
Total	100.00€

Select Payment Method

By transfer By cheque

payable to: L’ASPIC

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