INSCRIPTION

Fan Club International

     

Hello, Seuqcaj Named is happy to accommodate you! Thanks for agreeing to fill this form most completely as possible, in order to validate your inscription in the fan-club.

After having read and accept the information and conditions to become member of the Seuqcaj-fan-Club, I wants to register me like:   Simple Member       Full Member  

Civility: Mrs.  Miss  M.

Name :       First name:  

Date of birth:

Date where I really discovered Seuqcaj Named: 

Haveyou a Web site:    http:// 

I already met Seuqcaj Named into private (except spectacle):  

If so, which was the last time:  Place:    Date:  

Why I came on seuqcaj.net:  

How I knew seuqcaj.net: 

Which language you still speak: 

In order to as well as possible be able to be useful to you, we need your e-mail and other information

Mail:           

Fax:            

Adress:       

Postal code:     City:  

Country:  

 

Important: your information remains confidential and will not be communicated to tradesmen. Please send also a color photo of you, style identity card, for your member card. On: Fan-Club-Eng@seuqcaj.net

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