Please fill out the form opposite, then validate it by clicking the [Send] button below.

Beforehand you can print a copy by clicking the [Print...] button below.. Deco

Membership Application, Membership Renewal or Donation for Research Form

I have read the objectives of ARSER (statutes available on and I wish to: 

Title Last name First name
Postal address:
Email address: (ARSER members are informed par email)
Landline phone: mobile phone:
Other information:

● Minimum annual SUBSCRIPTION FEE is € 30.
  In return for your contribution and whatever its amount, you will receive a TAX RECEIPT allowing you in France to deduct 66 % of its amount from your income tax to be paid the following year: after tax reduction, a contribution of € 30 thus only amounts to € 10.20, while a contribution of € 90 only amounts to € 30.60.
●   An additional DONATION can be made to directly help medical RESEARCH.
(this donation is not tax deductible in France)

I of   payable to ARSER, comprising:
●  a Subscription part of  (in France, 66 % deductible from my tax),
●  a Donation part for research of  (not deductible in France).

I agree that, in the site directory only accessible to ARSER members, appear:


... or sign with the mouse while holding down its button in the box opposite =>

Bank details for a transfer (please specify "Subscription € xxx, Donation € yyy" in the reference):

Account number: 20041 01012 6701339E033
RIB Key:     53
IBAN:       FR41 2004 1010 1267 0133 9E03 353

Please send scanned form to:

Please send paper form and/or cheque to:

70 boulevard de l'Hôpital
75013 PARIS

*check as appropriate