Membership and Volunteer Application Form Edited

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PROUTIST UNIVERSAL MALTA

NON-GOVERNAMENTAL VOLUNTARY
ORGANIZATION
Office: 45 Triq Fleur De Lys, Birkirkara BKR 9062, Malta
+356 99755523 - [email protected] – https://pumalta.org
Reg. No. VO/1640 VAT No. 26950612 (exempt)

MEMBERSHIP APPLICATION FORM


1. Personal details
Full name
Date of birth
ID Card / Passport No.
Mobile No.
E-mail address
Home address

2. Membership type
☐ Standard member you support our mission, and you are welcome to take part to our annual general meeting.

☐ Volunteering member you support our mission, you are welcome to take part to our annual general meeting and you want to contribute
volunteering with us.

☐ Supporting member you support our mission, you are welcome to take part to our annual general meeting and you want to give monetary
support to fund our activities.

3. Newsletter
Do you give your consent to sign-up to our newsletter? ☐ YES ☐ NO
You can opt-out at any time by sending us an email or clicking “unsubscribe” in the newsletter.
4. Membership fee (Supporting Members only)
Amount given upon subscription EUR
Payment method
☐ Bank transfer IBAN: MT14VALL22013000000040026212942, payment description: Proutist membership fee Name Surname

☐ Cheque please issue to Proutist Universal Malta


☐ Paypal please send funds to [email protected])
☐ Cash
Date Signature

FOR OFFICE USE

Date received Reference No.

Signature

Please see our data protection policy on https://pumalta.org

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