(ASSOCIATION, SOCIO-CULTURAL CENTER, UNIVERSITY, HIGH SCHOOL, ELEMENTARY SCHOOL, CITY, VILLAGE, ETC)

Party name: ........................................................................................................

First and last name of the person in charge: ............................................................

Party address: .....................................................................................................

Postcode .............................................................................................................

Town ..................................................................................................................

Country ...............................................................................................................

Telephone ............................................................................................................

Fax......................................................................................................................

E-mail..................................................................................................................

Website................................................................................................................

I wish to financially support the humanistic project and become a citizen of the Brotherhood Boat: 

□ By cheque

Pay to the order of the Brotherhood Boat, send mail to: Association Le Bateau pédagogique

7 bis, rue Jacques-Cartier

44300 Nantes

France

□ By transfer

Recipient: Association Bateau pédagogique®

Bank Code: .................................

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Amount: ....................................

Bank account number: .................................

Bank: ....................................

Agency: ........................

International identification: ................................................ □ Via PayPal

□ Other (to be specified): ..............................................

I give: □ 1 € Contribution

□ I authorize the association to use my name for all of the necessary promotion forms for the development of the Brotherhood Boat project.

Date and signature: