Centro Studi Application

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

Asks

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

signature YOUR SIGNATURE

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:

by means of deposit on postal checking account n. 20969903 in the name of Associazione Centro Studi e Documentazione Isola di Ustica
by means of postal money order addressed to Centro Studi e Documentazione Isola di Ustica
by means of check or bank draft in the name of Centro Studi e Documentazione Isola di Ustica.

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

admitted on the LEAVE BLANK

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founding associate	Euro 259
sustaining associate	Euro 259
ordinary associate	Euro 104
adherent associate	Euro 52