Ustica  TODAY'S DATE dd-mm-yy
To the 
Directive Counsel
Island of Ustica Study and Documentation Center
Cortile Calderaro, 1
90010 Ustica (PA)
The underwritten  NAME
born at BIRTH PLACE on the BIRTH DATE profession JOB TITLE
residing at Street STREET NAME n STREET NUMBER
STATE STATE city CITY tel PHONE # e-mail E_MAIL 


To be admitted to the association in the level of
ordinary associate1
adherent associate1
sustaining associate1
to accepth the normal statutes and regulations of the association and to pledge to pay the annual fee.

1 indicate which level

Annual associate fees:
founding associate Euro 259
sustaining associate Euro 259
ordinary associate Euro 104
adherent associate Euro 52

The annual membership fees can be paid:

Associates recieve periodically the newsletter Lettera, books and copies of documents and publications regarding Ustica.
admitted on the LEAVE BLANK

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