Blackout APS - Digital Membership Application

First Name*

Last Name*

Date of Birth (18+)*

DD/MM/YYYY 📅

Place of Birth*

Email Address*

Confirm Email*

WhatsApp Phone Number (Optional / Facoltativo)

Desidero ricevere comunicazioni e aggiornamenti via WhatsApp relativi alla mia iscrizione.

Document Type*

Tax Code (Codice Fiscale) ID Card / CIE Driver's License Passport / Foreign / DoD ID

Italian Tax Code (Codice Fiscale)*

Official social documentation of BLACKOUT APS:

Association Bylaws / Statuto Internal Regulations Privacy Policy (GDPR)

I declare that I have read and fully accept the Association's Statute.* I declare that I have read and agree to the Internal Regulations.* I give consent to the processing of personal data (GDPR Privacy Policy).*

The undersigned, aware of the criminal penalties provided for false documents and declarations under Art. 76 of Presidential Decree No. 445/2000, declares under sole responsibility that all information provided is true.

CONFIRM*

Today's Date

Applicant's Signature*

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MEMBERSHIP APPLICATION FORM

01. Dati Anagrafici