MEMBERSHIP Each member receives a membership card by email or SMS with an ID number. This makes it easier to renew your membership. ACIRT MEMBERSHIP (This form must be completed by anyone aged 18 or over) Information about you Forms-en First and Last Name*(Required) Email Ages:(Required)18 - 2020 - 3030 - 4040 - 5050 - 6060 - 7070 - 8080 - 9090 - 100Gender *(Required) Female Male Other Socio-professional situation *(Required)employeeNot employedMarital status *(Required) YES (COUPLE / COMMON-LAW UNION) NO Your ContactsPhone *(Required)Geographic address *(Required) Address City * Postal code * Number of people in your family *(Required)123456789 I adhere to the statutes and I undertake to respect the internal regulations of the Association. (SEE ON THE ACIRT WEBSITE) Are you already a member *(Required) YES NO If already a member, please provide us with your ID number (bottom right of your card) * Membership Type * Individual ($30) Couple ($50) Business ($50) (Community Partner) Other Interact transfer to: INFO.ACIRT@GMAIL.COM Paypal Visa / Master card YOUR COMMENTS AND SUGGESTIONS TO THE ACIRT EXECUTIVE BOARDHiddenExpire Date MM slash DD slash YYYY