Post on 13-Apr-2015
description
Spett.le UNIONE BARRACELLI Via Padre Carboni 2 – 07040 Bessude (SS)
email: ub@unione‐barracelli.it fax: 079 0971177 cell.: 342 3801717
DOMANDA D’ISCRIZIONE ALL’ASSEMBLEA RAPPRESENTATIVA DENOMINATA “UNIONE BARRACELLI” Io sottoscritto ____________________________________________________________________
residente a _______________________________ in via _____________________________ n° ___
modalità di contatto telefonica _________________________ email ________________________
COMANDANTE della Compagnia dei Barracelli di ________________________________________
CHIEDO
di iscrivermi all’Assemblea rappresentativa denominata “Unione Barracelli” ai sensi dell’art. 5 dello
Statuto della stessa.
ALLEGO
alla presente l’elenco dei componenti della suddetta Compagnia che chiedono l’iscrizione alla
medesima “Unione Barracelli”.
A tale scopo e con la presente i firmatari autorizzano “Unione Barracelli” a rappresentarli in tutte
le sedi individuate dall’art. 2 dello Statuto, dichiarano inoltre di avere ricevuto le informazioni di
cui all’art. 13 del D.lgs. n. 196/2003, in particolare riguardo ai diritti ad essi riconosciuti dalla legge
ex art. 7 D.lgs. n. 196/2003 e acconsentono al trattamento dei miei dati personali al solo scopo di
ricevere comunicazioni da “Unione Barracelli”.
Luogo e data Firma del CAPITANO
_________________________________ _________________________________
- 1 -
* indicare se si ricopre la qualifica di segretario o vice comandante. - 2 -
Segue l’elenco dei componenti della Compagnia (si prega di scrivere in stampatello): COGNOME NOME RUOLO (grado, qualifica*) EMAIL FIRMA
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
* indicare se si ricopre la qualifica di segretario o vice comandante. - 3 -
Segue l’elenco dei componenti della Compagnia (si prega di scrivere in stampatello): COGNOME NOME RUOLO (grado, qualifica*) EMAIL FIRMA
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
* indicare se si ricopre la qualifica di segretario o vice comandante. - 4 -
Segue l’elenco dei componenti della Compagnia (si prega di scrivere in stampatello): COGNOME NOME RUOLO (grado, qualifica*) EMAIL FIRMA
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
* indicare se si ricopre la qualifica di segretario o vice comandante. - 5 -
Segue l’elenco dei componenti della Compagnia (si prega di scrivere in stampatello): COGNOME NOME RUOLO (grado, qualifica*) EMAIL FIRMA
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
* indicare se si ricopre la qualifica di segretario o vice comandante. - 6 -
Segue l’elenco dei componenti della Compagnia (si prega di scrivere in stampatello): COGNOME NOME RUOLO (grado, qualifica*) EMAIL FIRMA
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
* indicare se si ricopre la qualifica di segretario o vice comandante. - 7 -
Segue l’elenco dei componenti della Compagnia (si prega di scrivere in stampatello): COGNOME NOME RUOLO (grado, qualifica*) EMAIL FIRMA
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
* indicare se si ricopre la qualifica di segretario o vice comandante. - 8 -
Segue l’elenco dei componenti della Compagnia (si prega di scrivere in stampatello): COGNOME NOME RUOLO (grado, qualifica*) EMAIL FIRMA
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
* indicare se si ricopre la qualifica di segretario o vice comandante. - 9 -
Segue l’elenco dei componenti della Compagnia (si prega di scrivere in stampatello): COGNOME NOME RUOLO (grado, qualifica*) EMAIL FIRMA
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
* indicare se si ricopre la qualifica di segretario o vice comandante. - 10 -
Segue l’elenco dei componenti della Compagnia (si prega di scrivere in stampatello): COGNOME NOME RUOLO (grado, qualifica*) EMAIL FIRMA
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
* indicare se si ricopre la qualifica di segretario o vice comandante. - 11 -
Segue l’elenco dei componenti della Compagnia (si prega di scrivere in stampatello): COGNOME NOME RUOLO (grado, qualifica*) EMAIL FIRMA
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________
__________________________ _______________________________ ______________________ __________________________________________