Coopérative d'habitant·e·s - Subscription - Galette v1.0.1

Identity:

Name:

First name:

Birth date:

(yyyy-mm-dd format)

E-Mail:

Contact information:

Address:

Zip Code:

City:

Phone:

Galette-related data:

Username: (at least 2 characters)

Captcha

I have twelve Galettes, a friend give me two more. How many Galettes do I have?

(numbers only)

Other information: