FORMULARIO DE INSCRIPCIÓN/MEMBERSHIP FORM
Bienvenido al formulario de inscripción de socios de PROEM-AID. Por favor, facilítanos algunos datos para darte de alta como socio/Welcome to PROEM-AID's membership form. Please provide us with some personal details to register you as a member.
Email address *
Datos Personales (Personal information)
Nombre y Apellidos (Name and Surname) *
Your answer
DNI/NIE (Passport number) *
Your answer
Fecha de Nacimiento (Date of Birth) *
MM
/
DD
/
YYYY
Nacionalidad (Nationality) *
Your answer
Datos de Contacto (Contact information)
Domicilio (Address) *
Your answer
Código Postal (Post Code) *
Your answer
Población (City) *
Your answer
Provincia (State/Province/County) *
Your answer
Teléfono (Phone number) *
Your answer
Correo Electrónico (Email) *
Your answer
Cuota (Membership Fee)
Cuota de socio -por favor, selecciona la cantidad con la que quieres colaborar (Membership fee -please select how much you would you like to contribute per month) *
Por favor, facilítanos un número de cuenta bancaria en formato IBAN para domiciliar tu cuota (Please, provide us with your bank account information in IBAN format to set up a standing order) *
Your answer
*
Required
A copy of your responses will be emailed to the address you provided.
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