Modulo di richiesta iscrizione

(LOOK OUT!! To fill in this form is an effective request of subscription)

After filling in the form and clicked on "submit" key, the system will ask you to confirm your datas again.
If you want to confirm them, click on the "continue" key, or, if you want to change something, click on the "cancel" key (you will be able to fill in the form again, to make any corrections).

Name:

Surname:

Address:

City:

Province:

CP:

Phone number:

E-Mail:

Country:

Comments (max 200 types):

We are considering the possibility to publish the e-mail address on our directory. When available, do you wish you r e-mail will be published on the directory?
if you will choose "No" your e-mail will be not pubblished on the directory, but it will be used by club only for information to members, in observance of Italian Privacy Law (D.L. n.196/03):

Si No

Remember the subscription to the club depends on the payment of the membership fee on our postal account n. 13882162, in name of "Associazione Guglielmo Marconi - Fermo posta - 16161 Genova/57" or sent by registered mail.

So, we will active the subscription, AT MEMBERSHIP FEE PAYMENT RECEIPT ONLY.

Then, we will send you an e-mail to confirm your assigned unit number (QRZ). Besides we will send you by mail the following material:

CM identity card
CM wall certificate
10 official QSLs
10 official sticks
CM rubber stamp
10 invitations card
members directory
CM official journal (three-four issues every year)

We will wait for you!!!!!