Request personal meeting

Please indicate mailing details :

Company

Mr. Mrs. Miss

Name *		First Name *
Address
Postal code	Town	Country
Phone number		Fax
E-mail *
	* Requested information

Would you like :	to be contacted by phone
	to have a representative visiting you

If you wish to stipulate other details please complete the request:

	I agree to receive, by e-mail, information from your company.

In accordance with the Loi Informatique et Libertés of the 6 January 1978 (the Computer and Freedoms law),you have the right to access and rectify any personal information pertaining to you.

Our company or association remains the sole receiver of any information sent to its attention.