[¯] I make a donation of : ......................................€
Enclosed Cheque, payable to the association freeGuppY. Receipts are written with the name that shows in the identification box.
In agreement with the Internet Freedom and Information laws about data protection issues, the privacy of personal information and their exclusive use for the association purposes are guaranteed. You always retain control of your information with freeGuppY
Title* : [¯] Mr, [¯] Mrs, [¯] Ms,
[¯] Firm, [¯] Ldt Company, [¯] Association,
[¯] other (specify) ......................................
Legal Form* : [¯] Private [¯] Company [¯] Association
Company name* ......................................
Surname*: ......................................
First name*: ......................................
Postal Address 1*: ......................................
Postal Address 2 : ......................................
Postal Code* : ......................................
Town * : ......................................
Country*: ......................................
E-mail*: ......................................
Username : ......................................
[¯] I give permission,
[¯] I don't give permission
for my name or my image to be used for purposes of communication solely by freeGuppY.*
You may enclose if you wish [¯] a passport photo, or [¯] a logo for legal entities.
Made in ...................................... on ......................................
Signature * (and stamp for moral entities) : ......................................
*=compulsory fields