Be partner

Identification

Full name*:

EHNA or other identity card number:

Date of birth:

yyyy/mm/dd

Contact information

Street number, street name and apartment number:

City:

Zip code:

Province or state:

Phone number:

Alternative phone number:

E-mail address*:

Alternative e-mail address:

Instructions

What language would you prefer to receive materials in?*:
Basque
French
Spanish

How would you like to receive materials?:
By e-mail
By regular mail

Membership

Type of membership*:
Regular member (100 € per year)
Supporting member
Benevolent member (benevolent members will be corporations and they will decide how they wish to contribute financially)

Form of payment:
600 € per year
Five year´s dues paid in advance

We will contact you to request bank details needed to effect payment

Other

Profession:

Company/place of work:

What languages do you speak?:

I have read and accept the conditions

In agreement with the established thing in Statutory law 15/1999, into protection of personal character data, we informed to him that their picked up personal data in this document will be included in a file automated under the GAINDEGIA responsibility, for the purposes of being able to manage the conditions and advantages for being partner.
It can exert its rights of access, cancellation, rectification and opposition by means of a writing in our direction, c MARTIN UGALDE KULTUR PARKEA z/g, 20140 ANDOAIN.
While the opposite does not communicate to us, we will understand that their data been have not modified and that it is committed to notify any variation to us and that we have the consent to use them in order to be able to fidelity the relation between both parts.

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About Gaindegia The Observatory Mission Statement Structure and tasks Original bases Works of the Observatory Reports Publications Weblinks Be partner Contact Post list Endowment Gaindegiaren laguntzaileak	Home Be partner Order form Please complete the following order form: Identification Full name: EHNA or other identity card number: Date of birth: yyyy/mm/dd Contact information Street number, street name and apartment number: City: Zip code: Province or state: Phone number: Alternative phone number: E-mail address: Alternative e-mail address: Instructions What language would you prefer to receive materials in?: Basque French Spanish How would you like to receive materials?: By e-mail By regular mail Membership Type of membership: Regular member (100 € per year) Supporting member Benevolent member (benevolent members will be corporations and they will decide how they wish to contribute financially) Form of payment: 600 € per year Five year´s dues paid in advance We will contact you to request bank details needed to effect payment Other Occupation: Business owner Professional Journalist Union member Academic Other Educational background: Pre-university University degree Doctorate Profession: Company/place of work: What languages do you speak?: I have read and accept the conditions In agreement with the established thing in Statutory law 15/1999, into protection of personal character data, we informed to him that their picked up personal data in this document will be included in a file automated under the GAINDEGIA responsibility, for the purposes of being able to manage the conditions and advantages for being partner. It can exert its rights of access, cancellation, rectification and opposition by means of a writing in our direction, c MARTIN UGALDE KULTUR PARKEA z/g, 20140 ANDOAIN. While the opposite does not communicate to us, we will understand that their data been have not modified and that it is committed to notify any variation to us and that we have the consent to use them in order to be able to fidelity the relation between both parts.
	GAINDEGIA. 943 30 43 65 Tel./Fax. - Posta-e. Martin Ugalde Kultur Parkea. Gudarien Etorbidea 8, 20140 Andoain

Order form