Adhérer à la CPTS

Information adhérent
Nom*
Prénom*
Date de naissance*
E-mail*
Username d-none*
Mot de passe*
Répéter votre mot de passe*
Téléphone portable*
Téléphone fixe
Profession*
Adresse professionnelle*
Code postal*
Ville*
Numéro RPPS ou Adeli*
Je déclare par la présente souhaiter devenir membre de la CPTS.*
A ce titre, je déclare reconnaître l'objet de l'institution, et en avoir accepté les statuts.*
J'ai pris bonne note des droits et des devoirs des membres de l'association, et accepte de verser ma cotisation due pour l'année en cours.*
- J’accepte apparaître sur la cartographie de la CPTS du VEXIN Francilien.
Je souhaite m'inscrire à la lettre d'information de la CPTS.
Montant des cotisations
Adhérent - 20€ until 31 décembre 2024
Honeypot

Before you can accept payments, you need to connect your Stripe Account by going to Dashboard -> Paid Member Subscriptions -> Settings -> Payments

Billing Details
Billing First Name*
Billing Last Name*
Billing Email*
Billing Company
If entered, this will appear on the invoice, replacing the First and Last Name.
Billing Address*
Billing City*
Billing Zip / Postal Code
Billing Country*
Billing State / Province

Cookie	Type	Duration	Description
__stripe_mid		1 year	This cookie is set by Stripe payment gateway. This cookie is used to enable payment on the website without storing any patment information on a server.
__stripe_sid		30 minutes	This cookie is set by Stripe payment gateway. This cookie is used to enable payment on the website without storing any patment information on a server.
_GRECAPTCHA		5 months 27 days	This cookie is set by the Google recaptcha service to identify bots to protect the website against malicious spam attacks.
cookielawinfo-checkbox-necessary	0	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-non-necessary	0	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Non Necessary".
viewed_cookie_policy	0	11 months	The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.

Cookie	Duration	Description
_ga	2 years	The _ga cookie, installed by Google Analytics, calculates visitor, session and campaign data and also keeps track of site usage for the site's analytics report. The cookie stores information anonymously and assigns a randomly generated number to recognize unique visitors.
_ga_6GN3DV45FN	2 years	This cookie is installed by Google Analytics.
_gat_gtag_UA_208773469_1	1 minute	Set by Google to distinguish users.
_gid	1 day	Installed by Google Analytics, _gid cookie stores information on how visitors use a website, while also creating an analytics report of the website's performance. Some of the data that are collected include the number of visitors, their source, and the pages they visit anonymously.

Information adhérent