Per iscriverti compila questo form e inviaci la documentazione completa. Riceverai direttamente a casa la tua smart card.

NB Se ancora non sei socio di Legambiente, ma vuoi usufruire degli sconti riservati ai tesserati Legambiente, scarica dalla pagina "COME ABBONARSI" il modulo RID - LEGAMBIENTE oppure CARTA DI CREDITO - LEGAMBIENTE e inviacelo compilato e firmato insieme alla documentazione car sharing.

* Campi obbligatori

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ABBONAMENTO IN GERARCHIA?*

Sì

No

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GARANTE DELL'ABBONAMENTO IN GERARCHIA
(da compilare solo nel caso di abbonamento in gerarchia)
Nome Cognome

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GESTORE D'APPARTENENZA* scegli... MILANO

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TIPO DI CONTRATTO:

SOCI LEGAMBIENTE - BUSINESS

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PAGAMENTO CON
(da compilare solo nel caso di abbonamento non in gerarchia)

Carta di credito - Car Sharing

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DATI ANAGRAFICI:

NOME*

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COGNOME*

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NATO A*

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IL (gg/mm/aaaa)*

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PROFESSIONE

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RESIDENTE IN:

INDIRIZZO* CAP*

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COMUNE* PROVINCIA*

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NAZIONE* scegli... Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Anonymous Proxy Antarctica Antigua and Barbuda Argentina Armenia Aruba Asia/Pacific Region Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Congo, The Democratic Republic of the Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europe Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Satellite Provider Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Yemen Zambia Zimbabwe

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DOMICILIO IN (da compilare solo se diverso dalla residenza):

INDIRIZZO CAP

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COMUNE PROVINCIA

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NAZIONE scegli... Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Anonymous Proxy Antarctica Antigua and Barbuda Argentina Armenia Aruba Asia/Pacific Region Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Congo, The Democratic Republic of the Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europe Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Satellite Provider Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Yemen Zambia Zimbabwe

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RECAPITI:

TEL. ABITAZIONE FAX

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TEL. UFFICIO CELL*

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INDIRIZZO EMAIL*

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DOCUMENTI:

CODICE FISCALE (obbligatorio solo nel caso di nazione di residenza Italia)

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RAGIONE SOCIALE*

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PARTITA IVA*

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DOCUMENTO D'IDENTITÁ NUMERO*

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PATENTE NUMERO*

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CATEGORIA PATENTE* scegli... ABCD

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DATA RILASCIO PATENTE (gg/mm/aaaa)*

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LUOGO RILASCIO PATENTE

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DATA SCADENZA PATENTE (gg/mm/aaaa)*

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PRIVACY*
Il/la sottoscritto/a acconsente al trattamento dei dati personali per i fini indicati nella normativa. Decr.Lgs Privacy n.196/2003

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