Modulo di iscrizione

Modulo di iscrizione 2021

La compilazione del modulo è nominativa e va compliata da ciascun membro dell’A.I.C.O.D.S.

* obbligatorio

Titolo *

Nome *

Cognome *

Indirizzo

Indirizzo

Indirizzo

Indirizzo

Città

Città

Prov.

Prov.

CAP

CAP

Indirizzo Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

Paese

Indirizzo Email *

Ordine * Santi Maurizio e Lazzaro Al Merito di Savoia Supremo Ordine della SS. Annunziata Croce Meritense Medaglia Mauriziana Civile di Savoia

Grado di appartenenza Cavaliere di Gran Croce Dama di Gran Croce Grand'Ufficiale Dama di Commenda Commendatore Ufficiale Cavaliere Dama Decorato

Delegazione Abruzzi e Molise Campania Calabria Lazio Liguria Lombardia Emilia Romagna Piemonte Puglie Sardegna Sicilia Toscana Marche Veneto Umbria Basilicata Trentino Alto Adige Friuli Venezia Giulia Alto Adige-Sud Tirolo (bolzano) Valle D Aosta Argentina Australia Austria Belgio E Lussemburgo Brasile Canada Corsica Costa Rica Finlandia Francia Germania Giappone Gibilterra Gran Bretagna Malta Messico Monaco Nizza Polonia Portogallo Repubblica Ceca Russia San Marino Savoia Scandinavia Spagna Svizzera Ungheria Usa Venezuela

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