ARE YOU A BOCCONI ALUMNUS OR A NON ALUMNUS? BECOME A MEMBER OF THE BOCCONI ALUMNI ASSOCIATION OR RENEW YOUR MEMBERSHIP Please, fill out this form, sign it and send it to us by fax +39 02 5836.5716 or by email [email protected] If you are a Bocconi Graduate or a SDA Bocconi Alumnus within three years, please download this form. Ordinary Member 2015 University Master Student Member 100 euro 100 euro Lifelong Member min. 250 euro Lifelong Honorary Member 5.000 euro (una tantum) I Contributing Member (Alumni) Contributing Member (Non Alumni) 10.000 euro (una tantum) min. 500 euro HEREBY AUTHORIZE A CHARGE TO BE MADE ON MY CREDIT CARD : American Express CARDHOLDER VISA / Mastercard N° EXPIRATION NAME DATE CVV AMOUNT If you choose permanent credit card charge, you will have a 25% discount on the annual fee for Ordinary Members (100 euros): you will be charged 75 euros for the first 3 years and starting in the fourth year the fee will once again be 100 euros. (You may cancel the permanent charge when you like; cancelations must be communicated in writing by the month of December before the new membership year). I authorize the automatic annual membership renewal on my credit card. You may choose alternative methods of payment: Cash or Cheque (in Secretary Offices) Wire transfer to current account n° 6200/20, ABI 05696, CAB 01610, CIN Q, SWIFT POSOIT22, IBAN IT 77 Q 05696 01610 000006200X20 - c/o Banca Popolare di Sondrio - Ag. 11, via Bocconi 8, 20136 Milan. Description: “Name, BAA membership 2015” or “Name, BAA membership - Contributing Member”. N.B.: for international wire transfer fees are not to be borne by the originator of the payment only P ERSONAL DATA NAME DATE SURNAME E-MAIL OF BIRTH HOME ADDRESS (ADDRESS, CITY, STATE/PROVINCE, ZIP CODE, COUNTRY) In accordance with Legislative Decree n. 106/2003 and successive formulations, I consent to the processing, communication and dissemination of my personal data by Università Commerciale Luigi Bocconi including its publication and transfer to the Bocconi Alumni Association and its subsidiaries in Italy and abroad. I consent I do not consent SIGNATURE Bocconi Alumni Association - piazza Sraffa 15 - 20136 Milano Tel. +39 02 5836.5715 - Fax +39 02 5836.5716 - e-mail: [email protected] - www.alumnibocconi.it ARE YOU A BOCCONI GRADUATE OR A SDA BOCCONI ALUMNUS BECOME A MEMBER OF THE BOCCONI ALUMNI ASSOCIATION WITHIN THREE YEARS? Please, fill out this form, sign it and send it to us by fax +39 02 5836.5716 or by email alumni@alumnibocconi. Ordinary Member 2015 Lifelong Member 50 euro 5.000 euro (una tantum) Lifelong Honorary Member Contributing Member (Non Alumni) 10.000 euro (una tantum) I min. 500 euro HEREBY AUTHORIZE A CHARGE TO BE MADE ON MY CREDIT CARD : American Express CARDHOLDER VISA / Mastercard N° EXPIRATION NAME DATE CVV AMOUNT If you choose permanent debit with a credit card, you will get a 25% discount on the annual fee for Ordinary Members (50 euros): we will debit 35 euros for 3 years and starting in the fourth year you will no longer have a discounted fee for new graduates. The standard Ordinary Member membership fee is 100 euros. (You may cancel the permanent charge when you like; cancelations must be communicated in writing by the month of December before the new membership year). I authorize the automatic annual membership renewal on my credit card. You may choose alternative methods of payment: Cash or Cheque (in Secretary Offices) Wire transfer to current account n° 6200/20, ABI 05696, CAB 01610, CIN Q, SWIFT POSOIT22, IBAN IT 77 Q 05696 01610 000006200X20 - c/o Banca Popolare di Sondrio - Ag. 11, via Bocconi 8, 20136 Milan. Description: “Name, BAA membership 2015” or “Name, BAA membership - Contributing Member”. N.B.: for international wire transfer fees are not to be borne by the originator of the payment only P ERSONAL DATA NAME DATE SURNAME E-MAIL OF BIRTH HOME ADDRESS (ADDRESS, CITY, STATE/PROVINCE, ZIP CODE, COUNTRY) In accordance with Legislative Decree n. 106/2003 and successive formulations, I consent to the processing, communication and dissemination of my personal data by Università Commerciale Luigi Bocconi including its publication and transfer to the Bocconi Alumni Association and its subsidiaries in Italy and abroad. I consent I do not consent SIGNATURE Bocconi Alumni Association - piazza Sraffa 15 - 20136 Milano Tel. +39 02 5836.5715 - Fax +39 02 5836.5716 - e-mail: [email protected] - www.alumnibocconi.it
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