Fields marked with * are mandatory. I'm of age YesNo Step 1: Your personal data Who are you? PrivateCompany Name/Company Name and Identity Card Number Contact Home Step 2: Choose your contribution Your contribution Amount *: euros · Regularity *: —Please choose an option—MonthlyQuarterlyHalf-yearlyAnnual from month —Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember/—Please choose an option—201420152016201720182019202020212022202320242025 Step 3: Your payment data Debit Bank account I.B.A.N Deduction from Income StatementCompany Tax I want to receive the certificate for the I.R.P.F.Company Tax purposes NoYes If yes, please fill in your Identity Card Number and your Zip Code. Other Information I confirm that I have read and accepted the Privacy legal advice. By submitting my information I authorize Delwende “at the Service of Life” to charge my membership fee in the bank account indicated above. Or if you prefer... You can also get off this form and return it to us filled out to Delwende al Servicio de la Vida. Plaza Madre Molas 1 - 28036 Madrid (Spain) or send it by email to socios@delwende.org. As contained in our statutes, minors must have parental consent or the person exercising parental authority or guardianship. You can contact us by going to Members and donors on this website to complete your membership status. Δ
