FES-TE SOCI
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SI US PLAU, OMPLE LES DADES DEL FORMULARI. Gràcies.
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<label >Nom <span>*</span></label>
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<input type="text" size="20" name="q0_Nom" value="" id="q0" onblur="validate(this,'Required')" maxlength="100" maxsize="100" />
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<label >Cognoms <span>*</span></label>
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<input type="text" size="20" name="q1_Cognoms" value="" id="q1" onblur="validate(this,'Required')" maxlength="100" maxsize="100" />
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<label >E-mail <span>*</span></label>
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<input type="text" size="20" name="q2_Email" value="" id="q2" onblur="validate(this,'Email')" maxlength="100" maxsize="100" />
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<label >Telefon Fix</label>
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<input type="text" size="9" name="q14_TelfonFix" value="" id="q14" onblur="validate(this,'Numeric')" maxlength="9" maxsize="9" />
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<label >Mobil</label>
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<input type="text" size="9" name="q15_Mbil" value="" id="q15" onblur="validate(this,'Numeric')" maxlength="9" maxsize="9" />
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<label >Adreça <span>*</span></label>
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<input type="text" size="20" name="q3_Adrea" value="" id="q3" onblur="validate(this,'Required')" maxlength="100" maxsize="100" />
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<label >Codi Postal <span>*</span></label>
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<input type="text" size="4" name="q4_CodiPostal" value="" id="q4" onblur="validate(this,'RequiredNumeric')" maxlength="4" maxsize="4" />
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<label >Poblacio <span>*</span></label>
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<input type="text" size="20" name="q10_Poblaci" value="" id="q10" onblur="validate(this,'Required')" maxlength="100" maxsize="100" />
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<label>Pais / Estat <span>*</span></label>
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<td>
<select name="q6_PasEstat" id="q6"onmouseover="ddrivetip('Catalunya', 200)" onmouseout='hideddrivetip()' onblur="validate(this,'Required')" >
<option></option>
<option>Abkhazia</option>
<option>Afghanistan</option>
<option>Aland</option>
<option>Albania</option>
<option>Algeria</option>
<option>American Samoa</option>
<option>Andorra</option>
<option>Angola</option>
<option>Anguilla</option>
<option>Antigua and Barbuda</option>
<option>Argentina Argentina</option>
<option>Armenia</option>
<option>Aruba</option>
<option>United Kingdom Ascension Island</option>
<option>Australia</option>
<option>Austria</option>
<option>Azerbaijan</option>
<option>The Bahamas</option>
<option>Bahrain</option>
<option>Bangladesh</option>
<option>Barbados</option>
<option>Belarus</option>
<option>Belgium</option>
<option>Belize</option>
<option>Benin</option>
<option>Bermuda</option>
<option>Bhutan</option>
<option>Bolivia</option>
<option>Bosnia and Herzegovina</option>
<option>Botswana</option>
<option>Brazil</option>
<option>Brunei</option>
<option>Bulgaria</option>
<option>Burkina Faso</option>
<option>Burundi</option>
<option>Cambodia</option>
<option>Cameroon</option>
<option>Canada</option>
<option>Cape Verde</option>
<option>Catalunya</option>
<option>Cayman Islands</option>
<option>Central African Republic</option>
<option>Chad</option>
<option>Chile</option>
<option>People's Republic of China</option>
<option>Republic of China</option>
<option>Christmas Island</option>
<option>Cocos (Keeling) Islands</option>
<option>Colombia</option>
<option>Comoros</option>
<option>Congo</option>
<option>Cook Islands</option>
<option>Costa Rica</option>
<option>Cote d'Ivoire</option>
<option>Croatia</option>
<option>Cuba</option>
<option>Cyprus</option>
<option>Czech Republic</option>
<option>Denmark</option>
<option>Djibouti</option>
<option>Dominica</option>
<option>Dominican Republic</option>
<option>Ecuador</option>
<option>Egypt</option>
<option>El Salvador</option>
<option>Equatorial Guinea</option>
<option>Eritrea</option>
<option>Estonia</option>
<option>Ethiopia</option>
<option>Falkland Islands</option>
<option>Faroe Islands</option>
<option>Fiji</option>
<option>Finland</option>
<option>France</option>
<option>French Polynesia</option>
<option>Gabon</option>
<option>The Gambia</option>
<option>Georgia</option>
<option>Germany</option>
<option>Ghana</option>
<option>Gibraltar</option>
<option>Greece</option>
<option>Greenland</option>
<option>Grenada</option>
<option>Guam</option>
<option>Guatemala</option>
<option>Guernsey</option>
<option>Guinea</option>
<option>Guinea-Bissau</option>
<option>Guyana Guyana</option>
<option>Haiti Haiti</option>
<option>Honduras</option>
<option>Hong Kong</option>
<option>Hungary</option>
<option>Iceland</option>
<option>India</option>
<option>Indonesia</option>
<option>Iran</option>
<option>Iraq</option>
<option>Ireland</option>
<option>Israel</option>
<option>Italy</option>
<option>Jamaica</option>
<option>Japan</option>
<option>Jersey</option>
<option>Jordan</option>
<option>Kazakhstan</option>
<option>Kenya</option>
<option>Kiribati</option>
<option>North Korea</option>
<option>South Korea</option>
<option>Kosovo</option>
<option>Kuwait</option>
<option>Kyrgyzstan</option>
<option>Laos</option>
<option>Latvia</option>
<option>Lebanon</option>
<option>Lesotho</option>
<option>Liberia</option>
<option>Libya</option>
<option>Liechtenstein</option>
<option>Lithuania</option>
<option>Luxembourg</option>
<option>Macau</option>
<option>Macedonia</option>
<option>Madagascar</option>
<option>Malawi</option>
<option>Malaysia</option>
<option>Maldives</option>
<option>Mali</option>
<option>Malta</option>
<option>Marshall Islands</option>
<option>Mauritania</option>
<option>Mauritius</option>
<option>Mayotte</option>
<option>Mexico</option>
<option>Micronesia</option>
<option>Moldova</option>
<option>Monaco</option>
<option>Mongolia</option>
<option>Montenegro</option>
<option>Montserrat</option>
<option>Morocco</option>
<option>Mozambique</option>
<option>Myanmar</option>
<option>Nagorno-Karabakh</option>
<option>Namibia</option>
<option>Nauru</option>
<option>Nepal</option>
<option>Netherlands</option>
<option>Netherlands Antilles</option>
<option>New Caledonia</option>
<option>New Zealand</option>
<option>Nicaragua</option>
<option>Niger</option>
<option>Nigeria</option>
<option>Niue</option>
<option>Norfolk Island</option>
<option>Turkish Republic of Northern Cyprus</option>
<option>Northern Mariana</option>
<option>Norway</option>
<option>Pakistan</option>
<option>Palau</option>
<option>Palestine</option>
<option>Panama</option>
<option>Papua New Guinea</option>
<option>Paraguay</option>
<option>Peru</option>
<option>Philippines</option>
<option>Pitcairn Islands</option>
<option>Poland</option>
<option>Portugal</option>
<option>Transnistria Pridnestrovie</option>
<option>Puerto Rico</option>
<option>Qatar</option>
<option>Romania</option>
<option>Russia</option>
<option>Rwanda</option>
<option>Saint Barthelemy</option>
<option>Saint Helena</option>
<option>Saint Kitts and Nevis</option>
<option>Saint Lucia</option>
<option>Saint Martin</option>
<option>Saint Pierre and Miquelon</option>
<option>Saint Vincent and the Grenadines</option>
<option>Samoa</option>
<option>San Marino</option>
<option>Saudi Arabia</option>
<option>Senegal</option>
<option>Serbia</option>
<option>Seychelles</option>
<option>Sierra Leone</option>
<option>Singapore</option>
<option>Slovakia</option>
<option>Slovenia</option>
<option>Solomon Islands</option>
<option>Somalia</option>
<option>Somaliland</option>
<option>South Africa</option>
<option>South Ossetia</option>
<option>Spain</option>
<option>Sri Lanka</option>
<option>Sudan</option>
<option>Suriname</option>
<option>Svalbard</option>
<option>Swaziland</option>
<option>Sweden</option>
<option>Switzerland</option>
<option>Syria</option>
<option>Tajikistan</option>
<option>Tanzania</option>
<option>Thailand</option>
<option>Timor-Leste</option>
<option>Togo</option>
<option>Tokelau</option>
<option>Tonga</option>
<option>Trinidad and Tobago</option>
<option>Tristan da Cunha</option>
<option>Tunisia</option>
<option>Turkey</option>
<option>Turkmenistan</option>
<option>Turks and Caicos Islands</option>
<option>Tuvalu</option>
<option>Uganda</option>
<option>Ukraine</option>
<option>United Arab Emirates</option>
<option>United Kingdom</option>
<option>United States</option>
<option>Uruguay</option>
<option>Uzbekistan</option>
<option>Vanuatu</option>
<option>Vatican City</option>
<option>Venezuela</option>
<option>Vietnam</option>
<option>British Virgin Islands</option>
<option>US Virgin Islands</option>
<option>Wallis and Futuna</option>
<option>Western Sahara</option>
<option>Yemen</option>
<option>Zambia</option>
<option>Zimbabwe</option>
</select>
</td>
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<td width="150" valign="top" >
<label>Idioma <span>*</span></label>
</td>
<td>
<select name="q13_Idioma" id="q13" onblur="validate(this,'Required')" >
<option></option>
<option>Català</option>
<option>Deutsch</option>
<option>English</option>
<option>Español</option>
<option>Française</option>
</select>
</td>
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<td width="150" >
<label>Data Naixament</label>
</td>
<td>
<script type="text/javascript" src="http://www.jotform.com/js/datetimepicker.js?v2.0.772"></script>
<input type="text" size="10" name="q17_DataNaixament" id="q17" />
<a href="javascript:NewCal('q17','ddmmyyyy',false,12)">
<img src="http://www.jotform.com/images/cal.gif"border="0" alt="Pick a date" /></a>
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<td width="150" >
<label >NIF <span>*</span></label>
</td>
<td >
<input type="text" size="9" name="q27_NIF" value="" id="q27" onblur="validate(this,'Required')" maxlength="9" maxsize="9" />
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Imprescindible per poder desgravar-te les teves aportacions
de l'IRPF. T'enviarem un certificat.
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QUOTA i PERIODICITAT
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<label>Quota <span>*</span></label>
</td>
<td valign="top">
<input type="checkbox" name="q18_Quota[]" id="q18_0" value="60 per salvar el Tigre de Bengala" onblur="validate(this,'Required')" />
<label>60€ per salvar el Tigre de Bengala</label> <br />
<input type="checkbox" name="q18_Quota[]" id="q18_1" value="120 per als boscos vells del Pirineu" onblur="validate(this,'Required')" />
<label>120€ per als boscos vells del Pirineu</label> <br />
<input type="checkbox" name="q18_Quota[]" id="q18_2" value="250 per als pastors d Eti pia" onblur="validate(this,'Required')" />
<label>250€ per als pastors d'Etiòpia</label> <br />
<input type="checkbox" name="q18_Quota[]" id="q18_3" value=" L import que tu desitgis" onblur="validate(this,'Required')" />
<label>€ L'import que tu desitgis</label> <br />
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<label >Import desitjat <span>*</span></label>
</td>
<td >
<input type="text" size="6" name="q25_Importdesitjat" value="" id="q25" onblur="validate(this,'RequiredNumeric')" maxlength="6" maxsize="6" />
</td>
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<td width="150" valign="top" >
<label>Periodicitat <span>*</span></label>
</td>
<td>
<select name="q22_Periodicitat" id="q22" onblur="validate(this,'Required')" >
<option></option>
<option>cada mes</option>
<option>cada 2 mesos</option>
<option>cada 3 mesos</option>
<option>cada 6 mesos</option>
<option>un cop l'any</option>
</select>
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<td colspan="2" >
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<td colspan="2" >
DADES BANCARIES. Les dades viatgen en un servidor segur.
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<label >Titular <span>*</span></label>
</td>
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<input type="text" size="20" name="q35_Titular" value="" id="q35" onblur="validate(this,'Required')" maxlength="100" maxsize="100" />
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<label >Entitat Bancaria <span>*</span></label>
</td>
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<input type="text" size="20" name="q37_EntitatBancria" value="" id="q37" onblur="validate(this,'Required')" maxlength="100" maxsize="100" />
</td>
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<td width="150" >
<label >Codi Entitat <span>*</span></label>
</td>
<td >
<input type="text" size="4" name="q39_CodiEntitat" value="" id="q39" onblur="validate(this,'RequiredNumeric')" maxlength="4" maxsize="4" />
</td>
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<td width="150" >
<label >Codi Oficina <span>*</span></label>
</td>
<td >
<input type="text" size="4" name="q40_CodiOficina" value="" id="q40" onblur="validate(this,'RequiredNumeric')" maxlength="4" maxsize="4" />
</td>
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<label >Codi Seguretat <span>*</span></label>
</td>
<td >
<input type="text" size="2" name="q44_CodiSeguretat" value="" id="q44" onblur="validate(this,'RequiredNumeric')" maxlength="2" maxsize="2" />
</td>
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<td width="150" >
<label >Compte Corrent <span>*</span></label>
</td>
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<input type="text" size="10" name="q45_CompteCorrent" value="" id="q45" onblur="validate(this,'RequiredNumeric')" maxlength="10" maxsize="10" />
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</td>
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<input type="submit" value="Enviar" /> <input type="reset" value="Borarr" />
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UNEIX-TE A NOSALTRES... FES-TE SOCI DE WORLD NATURE
El millor suport... fer-vos socis! La vostra aportació, per petita que us pugui semblar, és molt important.
Els socis sou els membres de l'organització que la doteu de veu i finançament a llarg termini, tan necessari per als projectes de conservació i cooperació que, entre tots, realitzem.
Actualment el ritme de desparació d'espècies i hàbitats naturals és molt alt. Però hi podem fer moltes coses:
- Conservar espais naturals d'alt valor natural, mitjançant una gestió conjunta entre WN i els seus propietaris.
- Protegir espècies en vies d'extinció a partir de projectes especifics com els que duem a terme als Pirineus.
- Cooperar amb les comunitats humanes que viuen amb aquestes espècies i en aquests espais.
- Sensibilitzar i consienciar la societat a partir d'un esforç conjunt on el vostre suport i testimoni és molt important.
Apartir de 5€ al mes, un compromís important.
Gràcies.
+(34) 616 479 084
info@world-nature.org
world-nature