Contact the GAC-EPA (Groupement des Anciens du CERN - ESO Pensioners' Association) (explanations for filling in this form)
Your message
To:  Information Sessions ("permanences")  Pensions Commission  Pension Guarantees  Health Insurance Scheme (CHIS)  Health working group ESO  Commission on Legal Matters  Mutual Aid Fund  Social Activities  Bulletin  President  ESO representative  Treasury  Secretariat  Webmaster  Other (use this if you are not sure which of the above functions to address)	Subject: Message:
Your coordinates
title	first name	family name
(select) Mr. Ms. Mrs Prof. Dr.
your e-mail address
re-type your e-mail address:	(both e-mail addresses must be identical)
You will receive a copy of the content of this form by e-mail.
Protection
Protection against unsollicited messages:  before you can submit your data, click the digits in the grid on the right to make the four digit verification code. verification code:

Privacy:  the data sent in this form will remain confidential;  they will be sent to one or more Committee members responsible for the destination you chose.