MIEUX NOUS CONNAÎTRE POUR MIEUX NOUS SOUTENIR

13.08.2007

MODEM<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>

Bezons, le 11 août 2007.<o:p></o:p>

<o:p> </o:p>

<o:p> </o:p>5 ème Circonscription<o:p></o:p>

<o:p> </o:p>

<?xml:namespace prefix = v ns = "urn:schemas-microsoft-com:vml" /><v:rect id=_x0000_s1026 style="MARGIN-TOP: -6.3pt; Z-INDEX: -66; LEFT: 0px; MARGIN-LEFT: 126.95pt; WIDTH: 306pt; POSITION: absolute; HEIGHT: 21.05pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f" fillcolor="#ff9"><v:path arrowok="t"></v:path><?xml:namespace prefix = w ns = "urn:schemas-microsoft-com:office:word" /><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1027 style="MARGIN-TOP: -6.3pt; Z-INDEX: -65; LEFT: 0px; MARGIN-LEFT: 126.95pt; WIDTH: 306pt; POSITION: absolute; HEIGHT: 21.05pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight="3.12pt" strokecolor="#f60" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect>MIEUX NOUS CONNAÎTRE POUR MIEUX NOUS SOUTENIR<o:p></o:p>

<o:p> </o:p>

- Connaissez-vous le Modem? Oui Non*<o:p></o:p>

.Voulez-vous mieux nous connaître? Oui Non*<o:p></o:p>

. Rencontrer des responsables locaux de votre secteur?<o:p></o:p>

. Recevoir un courrier d'information ponctuel?<o:p></o:p>

<v:rect id=_x0000_s1028 style="MARGIN-TOP: -66.4pt; Z-INDEX: -64; LEFT: 0px; MARGIN-LEFT: 17pt; WIDTH: 552pt; POSITION: absolute; HEIGHT: 149.95pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f" fillcolor="#ff9"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1029 style="MARGIN-TOP: -66.4pt; Z-INDEX: -63; LEFT: 0px; MARGIN-LEFT: 17pt; WIDTH: 552pt; POSITION: absolute; HEIGHT: 149.95pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight="3.12pt" strokecolor="#f60" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1030 style="MARGIN-TOP: -25.15pt; Z-INDEX: -62; LEFT: 0px; MARGIN-LEFT: 327.8pt; WIDTH: 13.45pt; POSITION: absolute; HEIGHT: 9.6pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1031 style="MARGIN-TOP: -25.15pt; 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Z-INDEX: -49; LEFT: 0px; MARGIN-LEFT: 312pt; WIDTH: 13.4pt; POSITION: absolute; HEIGHT: 9.8pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight=".72pt" strokecolor="navy" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect>. Recevoir le journal du Modem ?<o:p></o:p>

. Participer à une réunion d'information?<o:p></o:p>

. Assister (participer*) à un débat sur les idées défendues par le Modem ?<o:p></o:p>

. Assister (participer*) à un débat sur les grands thèmes de la politique française internationale*?<o:p></o:p>

. Assister à un débat sur l'Europe: Constitution, institutions, fonctionnement*?<o:p></o:p>

<o:p> </o:p>

- Êtes-vous disposé(e) à participer à une manifestation de soutien du Modem ? Oui Non*<o:p></o:p>

<v:rect id=_x0000_s1044 style="MARGIN-TOP: -20.55pt; Z-INDEX: -48; LEFT: 0px; MARGIN-LEFT: 16.05pt; WIDTH: 552pt; POSITION: absolute; HEIGHT: 50.8pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f" fillcolor="#ff9"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1045 style="MARGIN-TOP: -20.55pt; Z-INDEX: -47; LEFT: 0px; MARGIN-LEFT: 16.05pt; WIDTH: 552pt; POSITION: absolute; HEIGHT: 50.8pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight="3.12pt" strokecolor="#f60" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1046 style="MARGIN-TOP: 1.95pt; Z-INDEX: -46; LEFT: 0px; MARGIN-LEFT: 319.4pt; WIDTH: 13.45pt; POSITION: absolute; HEIGHT: 9.6pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1047 style="MARGIN-TOP: 1.95pt; Z-INDEX: -45; LEFT: 0px; MARGIN-LEFT: 319.4pt; WIDTH: 13.45pt; POSITION: absolute; HEIGHT: 9.6pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight=".72pt" strokecolor="navy" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1048 style="MARGIN-TOP: 16.1pt; Z-INDEX: -44; LEFT: 0px; MARGIN-LEFT: 116.15pt; WIDTH: 13.65pt; POSITION: absolute; HEIGHT: 9.85pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1049 style="MARGIN-TOP: 16.1pt; Z-INDEX: -43; LEFT: 0px; MARGIN-LEFT: 116.15pt; WIDTH: 13.65pt; POSITION: absolute; HEIGHT: 9.85pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight=".72pt" strokecolor="navy" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect>. Nationale? Convention meeting manifestation*?<o:p></o:p>

. Locale?<o:p></o:p>

<o:p> </o:p>

- Êtes-vous prêt(e) à vous impliquer dans l'action menée par le Modem ? Oui Non*<o:p></o:p>

. Au plan national?<o:p></o:p>

. Au plan local?<o:p></o:p>

<v:rect id=_x0000_s1050 style="MARGIN-TOP: -46.5pt; Z-INDEX: -42; LEFT: 0px; MARGIN-LEFT: 18pt; WIDTH: 552pt; POSITION: absolute; HEIGHT: 106.05pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f" fillcolor="#ff9"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1051 style="MARGIN-TOP: -46.5pt; Z-INDEX: -41; LEFT: 0px; MARGIN-LEFT: 18pt; WIDTH: 552pt; POSITION: absolute; HEIGHT: 106.05pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight="3.12pt" strokecolor="#f60" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1052 style="MARGIN-TOP: -27.3pt; Z-INDEX: -40; LEFT: 0px; MARGIN-LEFT: 162.7pt; WIDTH: 13.45pt; POSITION: absolute; HEIGHT: 9.85pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1053 style="MARGIN-TOP: -27.3pt; Z-INDEX: -39; LEFT: 0px; MARGIN-LEFT: 162.7pt; WIDTH: 13.45pt; POSITION: absolute; HEIGHT: 9.85pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight=".72pt" strokecolor="navy" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1054 style="MARGIN-TOP: -12.9pt; Z-INDEX: -38; LEFT: 0px; MARGIN-LEFT: 162.7pt; WIDTH: 13.45pt; POSITION: absolute; HEIGHT: 9.6pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1055 style="MARGIN-TOP: -12.9pt; Z-INDEX: -37; LEFT: 0px; MARGIN-LEFT: 162.7pt; WIDTH: 13.45pt; POSITION: absolute; HEIGHT: 9.6pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight=".72pt" strokecolor="navy" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1056 style="MARGIN-TOP: -0.15pt; Z-INDEX: -36; LEFT: 0px; MARGIN-LEFT: 439.4pt; WIDTH: 13.45pt; POSITION: absolute; HEIGHT: 9.55pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1057 style="MARGIN-TOP: -0.15pt; Z-INDEX: -35; LEFT: 0px; MARGIN-LEFT: 439.4pt; WIDTH: 13.45pt; POSITION: absolute; HEIGHT: 9.55pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight=".72pt" strokecolor="navy" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1058 style="MARGIN-TOP: 43.2pt; Z-INDEX: -34; LEFT: 0px; MARGIN-LEFT: 410.85pt; WIDTH: 13.7pt; POSITION: absolute; HEIGHT: 9.85pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1059 style="MARGIN-TOP: 43.2pt; Z-INDEX: -33; LEFT: 0px; MARGIN-LEFT: 410.85pt; WIDTH: 13.7pt; POSITION: absolute; HEIGHT: 9.85pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight=".72pt" strokecolor="navy" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1060 style="MARGIN-TOP: 15.15pt; Z-INDEX: -32; LEFT: 0px; MARGIN-LEFT: 434.15pt; WIDTH: 13.65pt; POSITION: absolute; HEIGHT: 9.85pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1061 style="MARGIN-TOP: 15.15pt; Z-INDEX: -31; LEFT: 0px; MARGIN-LEFT: 434.15pt; WIDTH: 13.65pt; POSITION: absolute; HEIGHT: 9.85pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight=".72pt" strokecolor="navy" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1062 style="MARGIN-TOP: 29.05pt; Z-INDEX: -30; LEFT: 0px; MARGIN-LEFT: 423.8pt; WIDTH: 13.45pt; POSITION: absolute; HEIGHT: 9.6pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1063 style="MARGIN-TOP: 29.05pt; Z-INDEX: -29; LEFT: 0px; MARGIN-LEFT: 423.8pt; WIDTH: 13.45pt; POSITION: absolute; HEIGHT: 9.6pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight=".72pt" strokecolor="navy" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect>. Réunions, débats, animations (préparation, organisation)?<o:p></o:p>

. Mises sous plis, distributions, tractages, affichages*?<o:p></o:p>

. Elections: préparation, organisation, réunions?<o:p></o:p>

. Bureaux de vote: assesseur, délégué*?<o:p></o:p>

<o:p> </o:p>

- Seriez-vous d'accord pour intégrer une équipe de travail*?<o:p></o:p>

Une équipe de responsables*? Oui Non*<o:p></o:p>

<v:rect id=_x0000_s1064 style="MARGIN-TOP: -30.15pt; Z-INDEX: -28; LEFT: 0px; MARGIN-LEFT: 18pt; WIDTH: 552.95pt; POSITION: absolute; HEIGHT: 88pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f" fillcolor="#ff9"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1065 style="MARGIN-TOP: -30.15pt; Z-INDEX: -27; LEFT: 0px; MARGIN-LEFT: 18pt; WIDTH: 552.95pt; POSITION: absolute; HEIGHT: 88pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight="3.12pt" strokecolor="#f60" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1066 style="MARGIN-TOP: 1.2pt; Z-INDEX: -26; LEFT: 0px; MARGIN-LEFT: 284.15pt; WIDTH: 13.65pt; POSITION: absolute; HEIGHT: 9.85pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1067 style="MARGIN-TOP: 1.2pt; Z-INDEX: -25; LEFT: 0px; MARGIN-LEFT: 284.15pt; WIDTH: 13.65pt; POSITION: absolute; HEIGHT: 9.85pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight=".72pt" strokecolor="navy" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1068 style="MARGIN-TOP: 15.6pt; Z-INDEX: -24; LEFT: 0px; MARGIN-LEFT: 268.55pt; WIDTH: 13.4pt; POSITION: absolute; HEIGHT: 9.6pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1070 style="MARGIN-TOP: 28.35pt; Z-INDEX: -22; LEFT: 0px; MARGIN-LEFT: 426pt; WIDTH: 13.4pt; POSITION: absolute; HEIGHT: 9.6pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1071 style="MARGIN-TOP: 28.35pt; Z-INDEX: -21; LEFT: 0px; MARGIN-LEFT: 426pt; WIDTH: 13.4pt; POSITION: absolute; HEIGHT: 9.6pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight=".72pt" strokecolor="navy" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1072 style="MARGIN-TOP: 43.2pt; Z-INDEX: -20; LEFT: 0px; MARGIN-LEFT: 202.55pt; WIDTH: 13.4pt; POSITION: absolute; HEIGHT: 9.85pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1073 style="MARGIN-TOP: 43.2pt; Z-INDEX: -19; LEFT: 0px; MARGIN-LEFT: 202.55pt; WIDTH: 13.45pt; POSITION: absolute; HEIGHT: 9.85pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight=".72pt" strokecolor="navy" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect>. Voudriez-vous faire partie de l'équipe locale?<o:p></o:p>

<v:rect id=_x0000_s1069 style="MARGIN-TOP: 2.25pt; Z-INDEX: -23; LEFT: 0px; MARGIN-LEFT: 265.05pt; WIDTH: 13.45pt; POSITION: absolute; HEIGHT: 9.6pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text; mso-position-horizontal: absolute; mso-position-vertical: absolute" strokeweight=".72pt" strokecolor="navy" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect>. De l'équipe départementale?<o:p></o:p>

. Du Conseil Départemental du Modem, ou du Bureau de la Fédération Modem95*?<o:p></o:p>

. Du Conseil National du Modem ?<o:p></o:p>

<o:p> </o:p>

- D'une façon générale, vous considérez-vous comme:<o:p></o:p>

<v:rect id=_x0000_s1074 style="MARGIN-TOP: -19.15pt; Z-INDEX: -18; LEFT: 0px; MARGIN-LEFT: 18.95pt; WIDTH: 552.95pt; POSITION: absolute; HEIGHT: 66.95pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f" fillcolor="#ff9"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1075 style="MARGIN-TOP: -19.15pt; Z-INDEX: -17; LEFT: 0px; MARGIN-LEFT: 18.95pt; WIDTH: 552.95pt; POSITION: absolute; HEIGHT: 66.95pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight="3.12pt" strokecolor="#f60" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect>. Pas du tout intéressé(e), un peu intéressé(e), intéressé(e), très intéressé(e)*?<o:p></o:p>

. Êtes-vous simplement à l'écoute, bienveillant(e), sympathisant(e), adhérent(e) potentiel(le)*?<o:p></o:p>

. Disposé(e) à nous écouter, à participer occasionnellement, activement*?<o:p></o:p>

<v:rect id=_x0000_s1076 style="MARGIN-TOP: 5.65pt; Z-INDEX: -16; MARGIN-LEFT: 19.05pt; WIDTH: 553.9pt; POSITION: absolute; HEIGHT: 86.8pt; mso-position-horizontal-relative: page; mso-position-vertical-relative: text; mso-position-horizontal: absolute; mso-position-vertical: absolute" stroked="f" fillcolor="#ff9"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><o:p></o:p>

<o:p> </o:p>

- Acceptez-vous de nous communiquer:<o:p></o:p>

- votre nom votre prénom : .. .<o:p></o:p>

<v:rect id=_x0000_s1077 style="MARGIN-TOP: -28.95pt; Z-INDEX: -15; LEFT: 0px; MARGIN-LEFT: 18.95pt; WIDTH: 553.9pt; POSITION: absolute; HEIGHT: 86.8pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight="3.12pt" strokecolor="#f60" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1078 style="MARGIN-TOP: -1.35pt; Z-INDEX: -14; LEFT: 0px; MARGIN-LEFT: 53pt; WIDTH: 52.1pt; POSITION: absolute; HEIGHT: 1.2pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f" fillcolor="#bfbfbf"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1079 style="MARGIN-TOP: -1.85pt; Z-INDEX: -13; LEFT: 0px; MARGIN-LEFT: 52.55pt; WIDTH: 52.05pt; POSITION: absolute; HEIGHT: 1.2pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f" fillcolor="navy"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect>Votre adresse .<o:p></o:p>

- celle d'amis ou proches à contacter...

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<o:p></o:p>

- votre téléphone/fax* ? . .<o:p></o:p>

- votre e-mail ? ... .<o:p></o:p>

<o:p> </o:p>

<v:rect id=_x0000_s1080 style="MARGIN-TOP: -5.45pt; Z-INDEX: -12; LEFT: 0px; MARGIN-LEFT: 18.95pt; WIDTH: 553.9pt; POSITION: absolute; HEIGHT: 21.8pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f" fillcolor="#ff9"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1081 style="MARGIN-TOP: -5.45pt; Z-INDEX: -11; LEFT: 0px; MARGIN-LEFT: 18.95pt; WIDTH: 553.9pt; POSITION: absolute; HEIGHT: 21.8pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" strokeweight="3.12pt" strokecolor="#f60" filled="f"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect>- Voulez-vous adhérer au Modem? Oui Non Pas maintenant*<o:p></o:p>

<o:p> </o:p>

<v:rect id=_x0000_s1090 style="MARGIN-TOP: 12.1pt; Z-INDEX: -2; LEFT: 0px; MARGIN-LEFT: 90.95pt; WIDTH: 367.65pt; POSITION: absolute; HEIGHT: 1.2pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f" fillcolor="#bfbfbf"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect><v:rect id=_x0000_s1091 style="MARGIN-TOP: 11.6pt; Z-INDEX: -1; LEFT: 0px; MARGIN-LEFT: 90.45pt; WIDTH: 367.7pt; POSITION: absolute; HEIGHT: 1.2pt; TEXT-ALIGN: left; mso-position-horizontal-relative: page; mso-position-vertical-relative: text" stroked="f" fillcolor="maroon"><v:path arrowok="t"></v:path><w:wrap anchorx="page"></w:wrap></v:rect>Merci de bien vouloir nous retourner ce questionnaire à l'adresse suivante: Madame Félicité Vincent 24 ter rue du Val Notre Dame 95870 Bezons<o:p></o:p>

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(* Rayer la(les) mention(s) inutile(s)<o:p></o:p>