Application Form

Personal data

Name

Surname

Date of birth

Date of birth :: Please use the "dd/mm/yyyy" format.

Place of birth

Nationality

Contact details

e-mail

Mobile phone

Mobile :: Please remember the calling code (e.g.: +39..number..).

Telephone

Address

Town

Post Code

Country

Membership details

I need to:

For the year

Type of membership

standard >> € 25
student >> € 15
joint >> € 40
companies >> € 100

Partner name

Company

Payment

Payment method:

Cash at Circolo's office
Payment to our bank account
Credit card - follow instructions later

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