Membership Registration Form

PERSONAL DETAILS

Membership

New

Renewal

Membership Number (only for renewal)

First Name

Last Name

Nationality

Sex

Female

Male

Age

Less than 30

Over 30

Date of birth if less than 30 years old

Street Address

City

Postal Code

Country

Mobile Phone

Email Address

Preferred Language

English

French

Italian

German

Spanish

Membership Type

Individual (1 year) : 50€

Individual (1 year) - Couple option : 65€

Individual (3 years) : 140€

Individual (3 years) - Couple option : 185€

Sustainer (1 year) : 100€

Sustainer (1 year) - Couple option : 115€

Young (under 30 years old) : 25€

Young (under 30 years old) - Couple option : 40€

DETAILS OF COUPLE MEMBERSHIP (only for Membership with "Couple option" )

First Name

Last Name

Sex

Female

Male

Email Address

Notes

Privacy

In accordance with Italian legislative decree no. 196/03, I hereby grant permission for the use of my personal information for Slow Food association purposes and activities.

PAYMENT INSTRUCTIONS : By bank transfer to SlowFood Grand-Duché Asbl using the bank details set forth below.

SFG-D Bank Account Number (IBAN)

SFG-D Bank Account BIC / Swift Code

Communication

Please enter the code:

The Privacy Policy applies.

Note: Please fill out the fields marked with an asterisk.