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Tel+41754141121 |
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wo we are
-fill out the registration form
- make your payment
-fill out the Living Will
-send all material to Exit-Italia, Corso Monte Cucco 144, 10141 Torino
(you’ll receive a certified copy of your Living Will and your Exit-Italia membership card)
- contact us by email: info@exit-svizzeraitaliana.org or by telephone:
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REGISTRATION FORM
I (name) ............................................. born (date or birth) …………… in (place of birth)………….., currently a resident at: Street, Number ................, City.............. State ………… Zip Code..............
Telephone ........................... Cell....................... Fax ................................ Email ...........................................
Hereby request to register as (indicate your choice):
? - Ordinary Member: Membership Fee € 50.00
(annual dues, following year of registration: € 25.00)
? - Supporting Member: Membership Fee € 100.00
(annual dues, following year of registration: € 25.00)
?- Lifelong Member: Membership Fee € 800.00
(Single payment of registration fees only.)
Lifelong Members pay only a registration fee of € 800.00 and no other membership fees or dues.
TO MAKE YOUR PAYMENT
a- Italian Postal Bill: to the order of EXIT-ITALIA, C.so Monte Cucco,
144 - 10141 Torino
Account no. 39167101 – include your first name, last name and address
on the bill.
b.- Credit Transfer: indicate your first name, last name, address
and complete IBAN.
IBAN = IT03Q0760101000000039167101
BIC : BPIITRRXXX
Legible Signature and Handwritten Date
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