APPLICATION FOR MEMBERSHIP
To the attention of the Executive Board of
ASSOCIAZIONE CULTURALE LA CONVENTICOLA DEGLI ULTRAMODERNI
Via di Porta Labicana no. 32-00185 Rome - Italy -IVA. 15426691000.conventicola@pec.it
The Cultural Association La Conventicola degli Ultramoderni is duly affiliated with the organization LIBERTAS.
The Association carries out cultural activities on a non-profit basis. Contributions from supporting members are used for the production of performances, research activities, educational programs, and the maintenance of the Association's premises.
The Association's activities are aimed at promoting and disseminating the history of Italian music, the history of variety entertainment and stage costume, as well as enhancing early twentieth-century and modern dance and burlesque performance.
The Association's premises are open to supporting members exclusively during performances and activities organized by the Association.
Applicant Information (All fields are mandatory)
Name :
*
Surmane :
*
Place of Birth:
*
Date of Birth:
*
-
Month
-
Day
Year
Date Picker Icon
Tax Code (Codice Fiscale - Italy only, for residents of Italy):
*
Contact Information
Telephone:
Format: (000) 000-0000.
E-mail:
example@example.com
The undersigned acknowledges that all official communications will be sent exclusively by email.
Application for Admission
The undersigned hereby applies for admission as a member of the Cultural Association La Conventicola degli Ultramoderni and agrees to comply with the Association's Bylaws, internal regulations, and resolutions.
Membership Card - The membership card is valid for 365 days from the date of admission.
Personal Data Processing - Pursuant to Regulation (EU) 2016/679 (GDPR), the undersigned authorizes the processing of personal data for membership purposes.
Signature of the Applicant:
Preview PDF
Submit
Should be Empty: