Application form for partners

Application form for partners

Application form for partners

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

Personal Details

First Name (*):

Last Name(s) (*):

ID/TIN (taxpayer number) (*):

Date of Birth (*):

Job :

Telephone Number (*):

email (*):

Province (*):

City/town (*):

Postal Code (*):

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

Name (*):

Number:

Stairway:

Floor:

Door Number:

Membership fee

Exact amount: (*):

On a... (*):

Bank account data (*)

IBAN
(4 digits):

Banking Institution
(4 digits):

Bank Office
(4 digits):

CD check digits
(2 digits):

Account Number
(10 digits):

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


Information for partners

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

In which language? (*):

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



You are a private individual, is that right? If you are a corporation, 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.With the modification of the Tax Law you will be tax-deductible more for your contribution (that applies for the IRPF tax). We will send you a receipt so that you can benefit from this fiscal deduction.

The personal data you provide us with will be treated in accordance with the General Data Protection Regulation, and included in an automated file. The purpose 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 / Secretario Coloma, 112, 1r, Edificio Podium, 08024 Barcelona, by telephone (93 418 47 62) or by email (mediterrania@medicusmundi.es)