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Spett.

leUNIONEBARRACELLI
ViaPadreCarboni207040Bessude(SS)
email:ub@unionebarracelli.it
fax:0790971177
cell.:3423801717

DOMANDADISCRIZIONEALLASSEMBLEARAPPRESENTATIVADENOMINATAUNIONEBARRACELLI

Io sottoscritto ____________________________________________________________________
residentea_______________________________invia_____________________________n___
modalitdicontattotelefonica_________________________email________________________
COMANDANTEdellaCompagniadeiBarracellidi________________________________________

CHIEDO

diiscrivermiallAssemblearappresentativadenominataUnioneBarracelliaisensidellart.5dello
Statutodellastessa.
ALLEGO
alla presente lelenco dei componenti della suddetta Compagnia che chiedono liscrizione alla
medesimaUnioneBarracelli.

AtalescopoeconlapresenteifirmatariautorizzanoUnioneBarracelliarappresentarliintutte
lesediindividuatedallart.2delloStatuto,dichiaranoinoltrediaverericevutoleinformazionidi
cuiallart.13delD.lgs.n.196/2003,inparticolareriguardoaidirittiadessiriconosciutidallalegge
exart.7D.lgs.n.196/2003eacconsentonoaltrattamentodeimieidatipersonalialsoloscopodi
riceverecomunicazionidaUnioneBarracelli.

LuogoedataFirmadelCAPITANO

__________________________________________________________________

-1-

SeguelelencodeicomponentidellaCompagnia(sipregadiscrivereinstampatello):

COGNOME

NOME

RUOLO(grado,qualifica*) EMAIL

FIRMA

__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
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__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
*indicaresesiricoprelaqualificadisegretarioovicecomandante.

-2-

SeguelelencodeicomponentidellaCompagnia(sipregadiscrivereinstampatello):

COGNOME

NOME

RUOLO(grado,qualifica*) EMAIL

FIRMA

__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
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__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
*indicaresesiricoprelaqualificadisegretarioovicecomandante.

-3-

SeguelelencodeicomponentidellaCompagnia(sipregadiscrivereinstampatello):

COGNOME

NOME

RUOLO(grado,qualifica*) EMAIL

FIRMA

__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
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__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
*indicaresesiricoprelaqualificadisegretarioovicecomandante.

-4-

SeguelelencodeicomponentidellaCompagnia(sipregadiscrivereinstampatello):

COGNOME

NOME

RUOLO(grado,qualifica*) EMAIL

FIRMA

__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
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__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
*indicaresesiricoprelaqualificadisegretarioovicecomandante.

-5-

SeguelelencodeicomponentidellaCompagnia(sipregadiscrivereinstampatello):

COGNOME

NOME

RUOLO(grado,qualifica*) EMAIL

FIRMA

__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
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__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
*indicaresesiricoprelaqualificadisegretarioovicecomandante.

-6-

SeguelelencodeicomponentidellaCompagnia(sipregadiscrivereinstampatello):

COGNOME

NOME

RUOLO(grado,qualifica*) EMAIL

FIRMA

__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
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__________________________ _______________________________________________________________________________________________
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__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
*indicaresesiricoprelaqualificadisegretarioovicecomandante.

-7-

SeguelelencodeicomponentidellaCompagnia(sipregadiscrivereinstampatello):

COGNOME

NOME

RUOLO(grado,qualifica*) EMAIL

FIRMA

__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
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__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
*indicaresesiricoprelaqualificadisegretarioovicecomandante.

-8-

SeguelelencodeicomponentidellaCompagnia(sipregadiscrivereinstampatello):

COGNOME

NOME

RUOLO(grado,qualifica*) EMAIL

FIRMA

__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
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__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
*indicaresesiricoprelaqualificadisegretarioovicecomandante.

-9-

SeguelelencodeicomponentidellaCompagnia(sipregadiscrivereinstampatello):

COGNOME

NOME

RUOLO(grado,qualifica*) EMAIL

FIRMA

__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
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__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
*indicaresesiricoprelaqualificadisegretarioovicecomandante.

- 10 -

SeguelelencodeicomponentidellaCompagnia(sipregadiscrivereinstampatello):

COGNOME

NOME

RUOLO(grado,qualifica*) EMAIL

FIRMA

__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
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__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
__________________________ _______________________________________________________________________________________________
*indicaresesiricoprelaqualificadisegretarioovicecomandante.

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