Società per gli Studi Naturalistici della Romagna (SSNR)

a no-profit Social Promotion Association

Official Seat: I - 47121 Forlì, Viale Roma 18 - Italy

Mail address: P.O. Box 143 I - 48012 Bagnacavallo RA - Italy

APPLICATION FORM

to be filled, signed and mailed either to the above mail address

or as a pdf file to info@ssnr.it

I the Undersigned (Name and Surname)

.....................................................................................................................

address..........................................................................................................

......................................................................................................................

e-mail ...........................................................................................................

profession (optional information).....................................................................

request to join "Società per gli Studi Naturalistici della Romagna"

special interest (optional information) ................................................................

.......................................................................................................................

In accordance with the Italian Law in defence of Privacy, the signature on the

Application Form means that "Società per gli Studi Naturalistici della Romagna"

is authorized to hold my name and address for mailing SSNR publications only.

Date .................................. Signature ..............................................................

Moreover I hereby authorize (or I do not authorize) SSNR to insert my name,
address, phone N° and e-mail in the list of Members periodically published in the bulletin of the association

YES NO

Signature ..........................................................................................................