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Ask for a card of the millesimes Please fill this form : Last name* : ..................................................... First name* : ...................................................... Adress* : ........................................................................................................................ Zip Code* : .................. Town* : ............................................. Country* : ........................... Tel. : ...................................................... Mobile : .......................................................... e-mail** : .................................................................@....................................................... * Compulsory form
filed Wish to receive free of charge and without any obligation : 1 Card of the Millesimes from 1900 till 2007 : join an envelope stamped in 0.56 euro Several Cards of the Millesimes from 1900 till 2007, clarify the number : .................................. limit of 10 cards per adress : join an envelope stamped in 0.90 euro Send this form, dated and signed, with the stamped envelope for return to : Robert
GORRETEAU Confidentiality Date : ....................................................... Signature :
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