IBC - Formulário de adesão

Para tornar-se sócio da "Instituto Bruno Comby",
favor preencher, imprimir e enviar este formulário ao seguinte endereço :

Instituto Bruno Comby
55 rue Victor Hugo, 78800 Houilles, France
Telefone: +33 1 30 86 00 33 - Fax: +33 9 55 29 00 22 ; E-mail: ibc-po[at]comby.org (spam prevention: replace [at] by @ in the e-mail)

 

Sobrenome* :

Nome* :

Endereço* :

Codigo postal* :

Cidade* :

Country* :

E-mail* :

Telefone :

Fax :

Profissao :

Age :

years

(*) Required zone  

 

ADESÃO : SIM, solicito a minha inscrição como sócio da Instituto Bruno Comby na qualidade de :

  Sócio Suportando : Eu aprovo sua ação (gratuito, emita a IBC pelo fax)
  Sócio Simpatizante: 25 Euros
  Sócio Ativo:  50 Euros
  Sócio Benfeitor: 100 Euros

Membro Simpatizante, Ativo o Benfeitor receberá um recibo pelo correio tradicional. Os membros novos são sujeitos ao acceptation pela diretores de IBC. Você será informado pela lista e-enviando de IBC.

SIM, eu concordo ser um correspondente local de IBC na seguinte area :
Donation adicional para suportar a Instituto : Euros

Pagamento incluido : EUROS em :
cartão de crédito cheque ordem bancária
a favor de : Instituto Bruno Comby

 

 

 

Data : Assinatura :

 

To sign, you can sign the printed paper version if you print this page on paper and send it by fax or mail, or please type into this "signature" zone your name or any alpha-numerical code legally representing your signature, for example : /John Smith/ or /jsmith8492xfp8902/ if this page is transmitted electronically.

 

FIRST STEP : print and send this completed page

This page should be printed and sent by fax to +33 9 55 29 00 22 or by e-mail in the form of a PDF file (if you pay by credit card or electronic wire transfer) or by postal mail (with the cheque, if you pay by cheque). By clicking on the "IMPRIMIR" button, you will print this page. You can also use the "Print" button in the menu of your navigating software.

 

 

 

SECOND STEP : send your payment by one of the three following methods 

Payment by credit card (in Euros): 1/ fill out, print (on paper or PDF), and fax the printed paper form to +33 9 55 29 00 22 or e-mail the PDF form to ibc-po[at]comby.org - (spam prevention: replace [at] by @ in the e-mail) - 2/ click on the visa card logo : and follow the instructions. Most credit cards are accepted (Visa, Mastercard, American Express...). The amount of your payment will be debited from your credit card account. Do not send your credit card number to AAEN, please make the payment yourself as indicated by clicking on the visa card above. The transmission of your credit card number is securized by https protocol.

Payment by cheque (in Euros): fill out, print, and send this membership registration form by traditional mail with your cheque. Cheques are to be denominated in EUROS and to be drawn on a French bank. If your bank is not in France, ask your banker to prepare a cheque drawn on a French bank. Eurocheques are not accepted.

Payment by wire transfer (in Euros): 1/ fill out, print (on paper or PDF), and fax the printed paper form to +33 9 55 29 00 22 or e-mail the PDF form to ibc-po[at]comby.org (spam prevention: replace [at] by @ in the e-mail) - 2/ send an e-mail to ibc-po[at]comby.org (spam prevention: replace [at] by @ in the e-mail) and ask for instructions concerning payment by wire transfer. You will receive instructions by e-mail.

According to the law, you have the right to access and correct the computerized information which concerns you.