join us


EXIT-SVIZZERA ITALIANA
CENTER OF STUDIES AND DOCUMENTATION
ON EUTHANASIA

exit-italia@fastwebnet.it

Tel:0039/011-7707126-0039/330512712

living will

HOW TO JOIN: 
-fill out the registration form 
- make your payment  
-fill out the Living Will
-send all material to Exit-Italia, Corso Monte Cucco 144, 10141 Torino 
(you’ll receive a certified copy of your Living Will and your Exit-Italia membership card) 
- contact us by email: exit-italia@fastwebnet.it or by telephone: 011/7707.126 
______________________________________ __________________________________
REGISTRATION FORM
I (name) ............................................. born (date or birth) …………… in (place of birth)………….., currently a resident at: Street, Number ................, City.............. State ………… Zip Code..............
Telephone ........................... Cell....................... Fax ................................ Email ...........................................
Hereby request to register as (indicate your choice):
? - Ordinary Member: Membership Fee € 50.00
(annual dues, following year of registration: € 25.00)
? - Supporting Member: Membership Fee € 100.00
(annual dues, following year of registration: € 25.00)
?- Lifelong Member:  Membership Fee € 800.00
(Single payment of registration fees only.)
Lifelong Members pay only a registration fee of € 800.00 and no other membership fees or dues.

TO MAKE YOUR PAYMENT

a- Italian Postal Bill: to the order of EXIT-ITALIA, C.so Monte Cucco, 144 - 10141 Torino
Account no. 39167101 – include your first name, last name and address on the bill.
b.- Credit Transfer: indicate your first name, last name, address and complete IBAN. 
IBAN = IT03Q0760101000000039167101
BIC :  BPIITRRXXX
Legible Signature and Handwritten Date
_________________________________________ __________________________________

EXIT-ITALIA is a nonprofit association, entitled to Italy’s 5/1,000 program for taxpayers, as indicated on 730 and Unico tax forms. To make your contribution, indicate the Exit-Italia tax code number 97573440019 on your tax form and sign where requested.


join us


EXIT-SVIZZERA ITALIANA
CENTER OF STUDIES AND DOCUMENTATION
ON EUTHANASIA

exit-italia@fastwebnet.it

Tel:0039/011-7707126-0039/330512712

living will