Club Giuliano Dalmato di Toronto

Club Giuliano Dalmato di Toronto
P.O. Box 1158 Station B, Etobicoke, Ontario, Canada M9W 5L6
~ 905.264.9918~
Domanda d’iscrizione di “Socia/o” - “Abbonamento“ al Club Giuliano Dalmato di Toronto.
Application form for “Membership” - “Subscription” to the Club Giuliano Dalmato of Toronto.
(Please Print In Clear Block Letters)
Cognomen: ___________________________________
(Family Name)
Nome: _______________________________________
(Given Name)
Luogo di Nascita: _____________________________________________________________________________
(Place of Birth)
Data di Nascita: ______________________________ Email: _________________________________________
(Date of Birth)
Residenza attuale Via/St.: _______________________________________________________________________
(Address)
Città: _________________________________ Provincia: ______________________
(City)
(Province)
__________________
(Country)
Codice Postale: _________________________ Telefono: ________________________________________
(Postal Code)
(Home Telephone Number)
Questa “Associazione” intende a preservare gli usi, costumi e tradizioni delle genti Giuliano-Dalmate nell’ambito
dell cultura Italiana.
The intent of this “Association” is to preserve and promote the Italian heritage, traditions and culture of
Giuliano-Dalmati.
(Please Circle Your Membership Request)
A)
B)
C)
D)
E)
F)
Junior Youth Membership - Socio-Prima Gioventù (1 to 15 Years Old) Fee: Free.
Youth Membership - Socio-Gioventù (16 to 19 Years Old) Fee: $15.00 per year / per anno.
Young Adult Member - Socio-Giovane Adulta/o (20 to 29 Years Old) Fee: $35.00 per year / per anno.
Socio-Adulta/o - Adult Membership (30 Years of Age and Older) Fee: $45.00 per anno / per year.
El Boletin Abbonamento Solo - El Boletin Subscription Only: $30.00 per anno / per year.
Internet Subscription Only - Internet Abbonamento Solo: $10:00 per year / per anno
Date: _________________ Sponsor:___________________________ Firma: ___________________________
( Please Print Name )
(Applicant’s or Sponsor’s Signature)
Restituire la domanda d’iscrizione con l’assegno indirizzato al Club.
Mail in your application with the appropriate fee payment as per your selection, to the Club’s address listed above.
Please make all Cheques payable to: “Club Giuliano Dalmato.”
Ringraziando anticipatamente cordiali saluti.
Thank you and best regards.
www.giulianodalmato.ca ~ www.giulianodalmato.it ~ www.giulianodalmato.eu ~ www.giulianodalmato.com
Form: NSM02-2015