Application form for corporations

Application form for corporations

Application form for corporations

You’re about to become an important part of it!

Organization details

Organization or company (*):

Identification Number (*):

Contact Person (*):

Telephone Number (*):

email (*):

Province (*):

Town (*):

Postal Code (*):

St. / Av. / Blvd. (*):

Name (*):

Number:

Stairway Identification Letter:

Floor:

Door Letter:

Membership fee

An amount of… (*):

On a... (*):

Bank account details (*)

IBAN
(4 digits):

Banking Institution
(4 digits):

Bank Office
(4 digits):

CD
(2 digits):

Account Number
(10 digits):

(N.B. We will send a receipt to your bank account. You must inform your bank office beforehand)


Information for members

What do you wish to be sent? (*):

In which language? (*):

Write the following letters and numbers (This is a security measure):captcha



We understand than you are a company, Is that right? If you are a private individual, this is your application form

Fields marked with an asterisk are mandatory fields and must be filled out.

This is a secure secured web page (https). Data transfer is encrypted.

We are an association declared to be of public utility.Thanks to recent modifications of the Tax Law, a greater portion of your contribution is tax deductible (this applies for the IRPF tax). We will send you a receipt so that you can benefit from this tax deduction.

The personal data  you provide us with will be treated in accordance with the European Data Protection Regulation, and included in an automated file. The purpose of this file is to manage membership and donations properly, as well as to inform you of our activities

You can exercise your rights of access, rectification, cancellation, opposition, limitation of the treatment and portability of the data by contacting Medicus Mundi Mediterrània, C / Pau Alsina, 112, 1r, Edificio Podium, 08024 Barcelona, by telephone (93 418 47 62) or by email (mediterrania@medicusmundi.es).