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(Région/État/Province)

Postal Code / Code Postal

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Phone Number / Numéro de Téléphone

Website / Site Web

1.
(EN)
I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this application. If this application is successful, I authorize AfLIA to keep this information for official use.

(FR)
Je déclare par la présente que les informations fournies sont vraies et correctes. Je comprends également que toute malhonnêteté volontaire peut entraîner le refus de cette candidature. Si cette candidature est retenue, j'autorise AfLIA à conserver ces informations pour un usage officiel. NO YES

2.
(EN)
I agree to the Terms and Conditions and Privacy Policy of AfLIA.

(FR)
J'accepte les Termes et Conditions et Politique de confidentialité de l'AfLIA. NO YES