Ius Primi Viri

International Assciation
Photo
APPLICATION FORM
The undersigned
Place of birth
Date of birth
Address:
street and no.
Zip code
Country 
E-mail
Nazionality
Tel. 
Fax
Profession
Body or Institute
Introduced by
agress completely with the Declaration of Intents and

 

APPLIES

for entering the Association as

Supporter Ordinary Member

binding himself/herself  to comply with the Statutes' rules and to

pay the Association's dues upon acceptance of the present application.

 

Yours faithfully

Date                       Signature

 

(Print and fax to: +39 06.807.73.06)

Please, complete and return this coupon with two picture and a short curriculum vitae to:

IPV - Ius Primi Viri

c/o C.E.U., Via Antonio Bertoloni, 29 - 00197 Roma (Italy)

E-mail: ipvroma@tin.it

 

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