Application form

Form for Ordinary Members

Associazione Internazionale Iter Vitis
Palazzo Panitteri
92017 Sambuca di Sicilia - Ag - (I)

To send via ordinary mail [email protected]

Subject: request for admission as member.

The undersigned__________________________________________________________________
as legal representative of ___________________________________________________________
Address__________________________City_______________________Province______________
e-mail____________________________________ internet________________________________
in view of the Statute and Regulation of the International Association Iter Vitis, sharing objectives
of promotion and improvement of wine and vine culture and of cultural, landscape, historical and
environmental heritage, committing with consistency in carrying out all the objectives posed by the
Cultural Route “Les Chemins de la Vigne”
ASKS
to be admitted as member of that Association.
I attach attestation of the € 1.000,00 (one thousand/00 euros) one-off payment of the
membership fee ,paid on the current account: Associazione Internazionale Iter Vitis, Banca
Sicana IBAN IT65 F089 8583 1000 1001 0007354 - SWIFT BIC: CCRTIT2TNIS
Best Regards.
NAME _____________________________STAMP and SIGNATURE__________________

PERSON OF CONTACT Name and
Surname_________________________________Role___________________________
e-mail________________________________________Mobile_____________________________
Tel____________________________________________Fax______________________________
Short description of the activities of the member/ history/ partecipation in European projects/ news:
________________________________________________________________________________
________________________________________________________________________________
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