10/11 Residentials, Flat 15, Block B, Triq Censu Tanti, St. Paul’s bay
Malta
Membership Application
Name: / ID Nr:
Surname:
Address:
Telephone:
Date of Birth:
Email:
Answers in the section below are optional and will be used solely for the objectives of the Hellenic Society of Malta (hereinafter referred to as ‘HSM’) in accordance with the provisions of the Data Protection Act (Cap. 440 Laws of Malta).
Other Personal Details:
City of residence in Greece
Marital Status
Number of Family Members:
Number of Children: / Age:
Educational Level :
Profession:
Please indicate your interest in specific actions / objectives of the HSM, if any (max three (3)?
For Internal Use:
Application Nr.
Receipt Nr.
Accepted by BoD:
Name:
Signature:
Your registration and subscription fees must accompany your application.
In signing and submitting this application, you acknowledge and accept personal responsibility for your conduct as a member of HSM and you agree to abide by the principles contained in the Statute of HSM. You release and discharge HSM, the members of its governing body, its agents and representatives from any liability whatsoever unless due to fraud, wilful misconduct or gross negligence on their part.
By submitting this application, you agree to the collection, use and processing of the personal information you provide to HSM in this membership application, in accordance with the provisions of the Data Protection Act (Cap. 440 Laws of Malta). This personal information will not be divulged to any third party, other than to appropriate authorities when HSM is legally required to do so. By submitting your personal information to HSM, you also agree that your information may be accessed and used by HSM, the members of its governing body, its agents and representatives.
You agree to notify HSM of any change to your personal information and make requests to access, check, delete or correct your personal information, so that it is accurate and current. You understand that the information requested in this application is necessary for administrative and planning purposes and that the failure to provide this information (save from the optional information) shall prevent your application from being properly processed.
Declaration
I have read, understood and accept the rules for membership as set in the Statute of HSM. I declare that all of the information provided is true and complete. I agree to the Member’s Agreement and Release stated above as well as to provide HSM with any additional information or documentary evidence in respect of this form upon request. I undertake to immediately inform HSM should there be any changes to the above.
Date / Signature