Yearly membership

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To the Governing Board
of Power Progress Community

Title _______ Name and Surname* _______________________________________

Place of birth ______________________________________________________

Date of birth (DD/MM/YYYY) ___________ Nationality* __________________________

Home Address _______________________________________ Postal code _______

City* _________________________________________ State or Province _______

Country* ______________________________________________________________

Mobile phone ___________________________ Web nickname* _________________

e-mail* _________________________________________________________

Occupation _______________________________________________________

* required fields

REQUEST
to become member of the POWER PROGRESS COMMUNITY association for the current year.

I have read, accept and will comply to the terms and conditions expressed in the statute of the Association, of which I share aims and objectives, and I also declare that I will comply to the resolution approved by the Association Bodies.

New membership   [  ]  or   Renewing membership  [  ]

The current yearly membership fee due is € 30.
A discounted membership fee of € 10 is available for students or for people coming from the so called “developing countries”. The list of countries falling into this group is the one as defined by the UNDP (United Nations Development Programme).

I would like to apply for a discounted membership fee  [  ]

The present request does not imply any commitment nor obligation for the next year.

I, the undersigned, declare that the information given in this application is correct and is given in good faith, and I accept what reported above.

Date ______________ Signature _______________________________________

I authorise the use of my personal data in compliance with the Italian Legislative Decree 196/2003 solely for performing actions strictly related to the Power Progress Community Association activities, that will keep this personal information confidential.

Date ______________ Signature _______________________________________

 

INSTRUCTIONS

The application form must be filled, printed, signed, scanned, then sent to
membership at powerprogress.org
Together with the scanned application form, please, provide the receipt of the € 30 credit transfer.

Payment method 1 – Bank credit transfer

These are the bank account details for donating

Bank name Banca Etica
Bank account owner POWER PROGRESS COMMUNITY
IBAN IT67 Z050 1801 6000 0000 0233 961
BIC SWIFT CCRTIT2T84A

Purpuse membership + YEAR + your NAME and SURNAME
(e.g..: “membership 2017 John Cocke”)

Payment method 2 – PayPal

You may send the donation using PayPal to




Thank you!
In this case, please add a comment providing your Name and Surname, otherwise we may unable to trace back who is the donor.
In the future we will activate a dedicated subscription page on the website http://www.powerprogress.org/

The application acceptance will be notified to the e-mail address specified in the form.