1. MEMBERSHIP REQUEST: I, the undersigned

Your name: (mandatory)

Your surname (mandatory)

Your birthname: jj/mm/aaaa
Your job:

Your email: (mandatory)

I would like to join the Association Henry Valensi, as:
Natural personRepresentative of a legal person governed by public lawRepresentative of a legal person governed by private law

2. EXPRESSION OF INTEREST: I declare that I have read the statutes of the association, and find the following interest:

To be informed of the various manifestations surrounding these actions (Newsletter, blog, discussion space, …).If necessary, benefit from the associated cultural advantages (reduction on museums, exhibitions, subscriptions to magazines, conferences, projections, …).

Here you can summarize your expectations:

3. DEDICATED OF COMMITMENT: I ​​wish (for the moment):

Be a simple active member.Become (as a natural or legal person) member benefactor, and as such, pay a higher annual fee, or make a donation, or help by your personal action in achieving some of the objectives of the association.To be a candidate in the election of the next Board of Directors.

4. SYNTHESIS: Reminder of statutory membership fees:

For the effective revival year of the association (2017), these amounts are as follows:

School and students: 10 €
Other: 30 €

In public law: 75 €
In private law: 100 €


By check to the attention of: « Association Henry Valensi », Association Henry Valensi c/o Didier Vallens: 156, rue Robespierre 93170 Bagnolet.By transfer (section MEMBERSHIP after sending your form).

Your country:
Your signdate: jj/mm/aaaa

Thank you!