A.I.Co.S. – Italian Scout Collectors Club – 2011 Application/Renewal Form

The Membership Secretary of A.I.Co.S.

c/o Lucio Ongarato

Via Franco, 26/L

36050 Quinto Vicentino (VI) - Italy

IF YOU HAVE SENT A SIMILAR FORM IN 2007 YOU DO NOT HAVE TO SEND IT AGAIN NOW UNLESS SOME OF YOUR INFO HAVE CHANGED

The undersigned confirms to agree on Statutes, policy, and general assembly decisions of AICoS (Associazione Italiana Collezionisti Scout). He also agrees to act, in his scout swapping activity, upon the moral and ethic principles of the Scout Law. As per 196/2003 Italian Privacy Decree, the undersigned gives his consent for AICoS to keep his personal and sensible data, as indicated below, and to use them for administrative purposes only.The undersigned also gives his consent for publishing his name and city of residence on AICoS bulletins, magazine and website. secure encrypted web pages (for Club members only).He also authorizes the publishing on AICoS bulletins, magazine and secure encrypted web pages (for Club members only) of the following personal information as specifically agreed hereunder (please delete YES or NO where appropriate): Full postal address: YES – NO; Original scout association: YES –NO; Home telephone: YES – NO; Mobile telephone: YES – NO; Email address: YES – NO; Special interests in scout collecting related to AICoS membership: YES – NO. It is understood that the undersigned may require at all times the cancellation of his data from the Club records and so doing heagree to renounce to his AICoS membership in case of cancellation of his main data.

The person in charge for the data keeping is the Membership Secretary in charge.

PLEASE COMPLETE IN BLOCK LETTERS ONLY AND SIGN

Surname and Name ______

Born on ______in ______

Full postal address ______

______

tel. ______mob ph. ______e-mail ______

Scout Assn, if any (*)______

Personal web site if any(*)______

Interests related to AICoS membership (*):

[ ]Scout badges/patches

[ ]Belt buckles

[ ]Scout stamps

[ ]Scout uniform

[ ]Scout books

[ ]Scout postcards

[ ]History of scouting

[ ]Other (please specify):

All required data, except if marked [*], are mandatory and for use of Membership Secretary.

Give more details, if any, on above marked interests [*]______

______

2011 membership fee: Italy€ 20; rest of Europe (Iban only) € 25; rest of the world € 30;

Annual membership payment receipt to be enclosed. Payment only by bank lodgement into:

IBAN / IT / 54 / P / 02008 / 11811 / 000100705277
CODICE PAESE / CHECK DIGIT / CIN / BANCA / CAB / N. CONTO

Bank account holder: Lucio Ongarato - Via Franco, 26/L - 36050 Quinto Vicentino (VI) - Italy - (this account is on the name of our treasurer, not in the name of AICoS).

Dated ______Applicant's Signature .
(or Parent/Guardian if applicant is under 18 years old)

AICOS/Domanda di adesione 2011