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INFORMATIONS PERSONNELLES POUR NOUVELLE ADHESION

(Les champs avec * sont obligatoires)

Nom

Prénom

Collège

1

2

Collège 1 : professionnels de la culture des conseils départementaux (directeur des affaires culturelles, directeur d’agences culturelles, directeurs d’EPCC et/ou leurs adjoints, responsables de service ou de mission) adhérents à titre individuel.
Collège 2 : collège des institutions, collectivités territoriales intercommunales ou départementales par exemple conseils départementaux, communautés de communes, communautés d’agglomérations, communautés urbaines, conseils généraux, ainsi que parcs naturels régionaux, pays…

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Code département

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Nom du département

Structure

Fonction

Adresse

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Code Postal

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Ville

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Cedex

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Téléphone bureau

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Téléphone mobile

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Email (Personnel pour collège 1 - Professionnel pour collège 2)

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J'autorise l'utilisation de l'adresse e-mail ci-contre par Culture et Départements (RGPD)

Valider