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\begin{center}
{\bf Membership form}
\end{center}

I undersigned {\sf Mr / Ms} \dotfill \\
certifies on the honor to have read and understood the \emph{ASRM rules and regulations} and I am committed to respect it.

In confirmation with the article 27 of the French law of ``Information and Freedom'' of January 6, 1978, you have the right of access and of rectification to your information.

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\begin{center}
  \begin{tabular}{ll}
    {\bf Subscription} \\
    \hline
    Subscription fee :  \\
    Cable :  \\
    Adaptator TU2 -- ET100 : \hspace{1.5cm} \\
    Misc. : \\
    Total amount :  \\
    \hline
    Paid by {\sf check / cash} \\ % US translation
  \end{tabular}
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\noindent Signed and accepted in Metz on (dd / mm / yyyy) : \\

\noindent\fbox{\begin{minipage}{.5\linewidth}
    The user:\\ \textsuperscript{\tiny Handwrite ``Read and accepted''}
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