DUTCH UNIVERSITY INSTITUTE FOR ART HISTORY FLORENCE
 
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DONOR APPLICATION FORM

Yes, I support the Dutch University Institute for Art History in Florence and wish to become a donor of the I Cinquecento Foundation. I will contribute in the following capacity (please indicate as appropriate):

 
INDIVIDUAL
 
25 Euro a year  
More than 25 Euro a year, namely
A one-off sum of at least 700 Euro
     This will make you a donor for life
 
 
STUDENT
 
10 Euro a year  
More than 10 Euro a year, namely
 
 
COMPANY
 
450 Euro a year  
More than 450 Euro a year, namely
A one-off sum of at least 4500 Euro
     This will make you a donor for life
 
 
PLEASE, FILL IN YOUR NAME AND ADDRESS
(fields marked with an asterix are mandatory)
 
Surname and initials*  
Address*
Postal code + Town/City*
Country*
Telephone number
E-mail
Date
 
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