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Form for subscribe and support our Foundation

Fondazione Alexander Langer Stiftung – Onlus

via Bottai 5 Bindergasse - 39100 BOLZANO/BOZEN (Italy)
Tel. + Fax 0471/977.691
E-mail: info@alexanderlanger.net

The Alexander Langer Foundation is searching for new Friends and supporters. For getting Friend or supporter of the Foundation please fill in the admission form in all parts (as for art. 12 and 14 of the Statute).
Please note that the contributions may be used for fiscal deductions as stipulated by the Italian law.

The undersigned

Last name

First name

Profession and/or voluntary activity

As representative of (in case)

is taking part in the foundation "Fondazione Alexander Langer Stiftung - Onlus" as per objectives indicated in the Statute approved by the foundation assembly dated 4th July, 1999.

He/she declares to have transferred the amount of Euro to the account of the Foundation

Banca/Bank: Cassa di Risparmio di BZ – Südtiroler Sparkasse, IBAN: IT91 S 060 4511 6130 0000 0555 000 for the following purpose:

a) to contribute with a one-time donation, as Friend of the Foundation, to found its capital (individual sum or collective sum from a group of persons) by means of an amount not inferior to 500 Euro

b) to contribute, as Patron of the Foundation, to its ordinary activities - individual annual sum not inferior to Euro 50

c) free donation to support the activities of the foundation or for specific purposes

Please note that the contributions may be used for fiscal deductions as stipulated by the Italian law.

Particulars:

place of birth

date of birth

Tel/Fax

resident in

ZIP code

street

E-Mail

tax code

I get the information forseen from art. 10 by law n. 675 from 31.12.1996 – under protection of the law of privacy and agree in sense of art. 11 – treatment of personal particulars.

Date

Document (kind and number)

Notes, proposals, availability:

I suggest to forward your information on the foundation also to: