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<table width="520" cellpadding="5" cellspacing="0">
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<td colspan="2" >
SI US PLAU, OMPLE LES DADES DEL FORMULARI. Gràcies.
</td>
</tr>
<tr >
<td width="150" >
<label >Nom <span>*</span></label>
</td>
<td >
<input type="text" size="20" name="q0_Nom" value="" id="q0" onblur="validate(this,'Required')" maxlength="100" maxsize="100" />
</td>
</tr>
<tr >
<td width="150" >
<label >Cognoms <span>*</span></label>
</td>
<td >
<input type="text" size="20" name="q1_Cognoms" value="" id="q1" onblur="validate(this,'Required')" maxlength="100" maxsize="100" />
</td>
</tr>
<tr >
<td width="150" >
<label >E-mail <span>*</span></label>
</td>
<td >
<input type="text" size="20" name="q2_Email" value="" id="q2" onblur="validate(this,'Email')" maxlength="100" maxsize="100" />
</td>
</tr>
<tr >
<td width="150" >
<label >Telefon Fix</label>
</td>
<td >
<input type="text" size="9" name="q14_TelfonFix" value="" id="q14" onblur="validate(this,'Numeric')" maxlength="9" maxsize="9" />
</td>
</tr>
<tr >
<td width="150" >
<label >Mobil</label>
</td>
<td >
<input type="text" size="9" name="q15_Mbil" value="" id="q15" onblur="validate(this,'Numeric')" maxlength="9" maxsize="9" />
</td>
</tr>
<tr >
<td width="150" >
<label >Adreça <span>*</span></label>
</td>
<td >
<input type="text" size="20" name="q3_Adrea" value="" id="q3" onblur="validate(this,'Required')" maxlength="100" maxsize="100" />
</td>
</tr>
<tr >
<td width="150" >
<label >Codi Postal <span>*</span></label>
</td>
<td >
<input type="text" size="4" name="q4_CodiPostal" value="" id="q4" onblur="validate(this,'RequiredNumeric')" maxlength="4" maxsize="4" />
</td>
</tr>
<tr >
<td width="150" >
<label >Poblacio <span>*</span></label>
</td>
<td >
<input type="text" size="20" name="q10_Poblaci" value="" id="q10" onblur="validate(this,'Required')" maxlength="100" maxsize="100" />
</td>
</tr>
<tr >
<td width="150" valign="top" >
<label>Pais / Estat <span>*</span></label>
</td>
<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>
</tr>
<tr >
<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>
</tr>
<tr >
<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>
</td>
</tr>
<tr >
<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" />
</td>
</tr>
<tr >
<td colspan="2" >
Imprescindible per poder desgravar-te les teves aportacions
de l'IRPF. T'enviarem un certificat.
</td>
</tr>
<tr >
<td colspan="2" >
</td>
</tr>
<tr >
<td colspan="2" >
QUOTA i PERIODICITAT
</td>
</tr>
<tr >
<td width="150" valign="top" >
<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 />
</td>
</tr>
<tr >
<td width="150" >
<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>
</tr>
<tr >
<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>
</td>
</tr>
<tr >
<td colspan="2" >
</td>
</tr>
<tr >
<td colspan="2" >
DADES BANCARIES. Les dades viatgen en un servidor segur.
</td>
</tr>
<tr >
<td width="150" >
<label >Titular <span>*</span></label>
</td>
<td >
<input type="text" size="20" name="q35_Titular" value="" id="q35" onblur="validate(this,'Required')" maxlength="100" maxsize="100" />
</td>
</tr>
<tr >
<td width="150" >
<label >Entitat Bancaria <span>*</span></label>
</td>
<td >
<input type="text" size="20" name="q37_EntitatBancria" value="" id="q37" onblur="validate(this,'Required')" maxlength="100" maxsize="100" />
</td>
</tr>
<tr >
<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>
</tr>
<tr >
<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>
</tr>
<tr >
<td width="150" >
<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>
</tr>
<tr >
<td width="150" >
<label >Compte Corrent <span>*</span></label>
</td>
<td >
<input type="text" size="10" name="q45_CompteCorrent" value="" id="q45" onblur="validate(this,'RequiredNumeric')" maxlength="10" maxsize="10" />
</td>
</tr>
<tr >
<td width="150" >
</td>
<td>
<input type="submit" value="Enviar" /> <input type="reset" value="Borarr" />
</td>
</tr>
</table>
</div>
</form>
</td>
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The best support ... make your partner! Your contribution, however small that might seem, it is very important.
The partners are members of the organization that doteu voice and long-term financing, as necessary forconservation projects and cooperation among all, actually.
Currently the rate desparació species and natural habitats is very high. But we can do many things:
Preserve natural areas of high natural value, through a joint management between WN and their owners.
Protecting endangered species from specific projects as we do in the Pyrenees.
Cooperate with the human communities that live with these species in these areas.
Awareness and consienciar society from a joint effort on your support and testimony is very important.
Only 5 € a month, a major commitment.
BECOME A MEMBER NOW for WN

Thanks.