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Subscription

AFSED : Association Française des Syndromes Ehlers Danlos

NB : The mandatory fields are in red

Identity:

Gender:

Do you manage a non profit organization, or a company? If you do so, check the box, and then enter its name in the field that will appear.

(yyyy-mm-dd format)

Contact information:


Galette-related data:

If you check this box (and if you are up to date with your contributions), your full name, website address ad other informations will be publically visible on the members list.
If you've uploaded a photo, it will be displayed on the trombinoscope page.
Note that administrators can disabled public pages, this setting will have no effect in that case.

(at least 2 characters)

Password image Please repeat in the field the password shown in the image.


Additionnal fields:
Medical data

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