“Dona Un Albero a Roma” (Donate a Tree to Rome)
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To Roma Capitale Dipartimento Tutela Ambientale – Protezione Civile U.O. Gestione Verde Pubblico Piazza di Porta Metronia, 2 00183 Roma [email protected] REGISTRATION FORM “Dona un albero a Roma” (Donate a Tree to Rome) I, the undersigned, _____________________________________________ born in ____________________________ in the Province of ________________________ on ___/___/_______, a resident of the municipality (Comune) of, ______________________ in the Province of ________________________ at: VIA _________________________________________nr. ___ CAP (postcode) ___________________ Tel ______/__________________________ Mobile______/_________________________ Fax _________________/ e-mail _____________________________________ @ ___________________________ DECLARE that I intend to take part in the “DONA UN ALBERO A ROMA” (Donate a Tree to Rome) project, by donating a total of _____________ tree/trees paying € 250.00 per tree (total amount € _____________.00) as a donation to Roma Capitale for the purchase and maintenance of the tree/s donated. specifying the area/areas (Municipio/Municipi, or administrative borough/s) in which the tree/s is/are to be planted: no. trees____type1 __________ □ MUNICIPIO I no. trees____type __________ □ no. trees____type __________ □ MUNICIPIO II MUNICIPIO IX no. trees____type __________ □ MUNICIPIO III no. trees____type __________ □ no. trees____type __________ □ MUNICIPIO IV MUNICIPIO X2 no. trees____type __________ □ MUNICIPIO V no. trees____type __________ □ no. trees____type __________ □ MUNICIPIO VI MUNICIPIO XI no. trees____type __________ □ MUNICIPIO VII no. trees____type __________ □ no. trees____type __________ □ MUNICIPIO VIII MUNICIPIO XII no. trees____type __________ □ MUNICIPIO XIII no. trees____type __________ □ MUNICIPIO XIV no. trees____type __________ □ MUNICIPIO XV Dedication request, if any (max. 140 characters): ____________________________________________________________ ________________________________________________________________________________________ ____________________________ ____________________________________________________________________________________ I, the undersigned, am aware that: I must choose the tree species in consultation with the technical staff of the parks and gardens service, (Servizio Giardini del Dipartimento Tutela Ambientale), to ensure compatibility with the plant life present in the area selected; planting shall take place at the appropriate time, during autumn/ winter) Please find attached: □ a pdf copy of a valid ID document; □ a copy of the bank transfer receipt3 totalling € 250.00 per tree donated to Roma Capitale, specifying : “Adesione al progetto Dona un Albero a Roma” (participation in the “Give Rome a Tree” project) as the reason for payment. The bank transfer to Roma Capitale, Tesoreria Comunale, leading bank (reference bank) Unicredit S.p.A., Via Monte Tarpeo, 41, can be made at any bank or post office (Banco Posta). The beneficiary’s bank data are as follows: IBAN code Country IBAN CIN ABI CAB C/C (current code account) IT 69 P 02008 05117 000400017084 BIC code (for transfers from abroad) SWIFT CODE UNCRITMM 1 To select the tree/s, users may access the photo gallery to find the corresponding code 2 Resolution upon participation in the project pending. 3 Payment may also be made to the municipal treasury office, Tesoreria Comunale – via Monte Tarpeo, 41 I, the undersigned, AUTHORISE the inclusion of my name in the Donor Register of “Un Albero a Roma” on the Roma Capitale web portal: YES NO I, the undersigned, also declare that: - Pursuant to art. 47 et seq. of Section V of Presidential Decree no. 445 of 28 December 2000, I am aware of the criminal law consequences of misrepresentation and of the drafting or use of false deeds as per art. 76 of said decree; - I am aware, pursuant to and in accordance with art. 13 of Legislative Decree no. 196/2003, that the personal data collected shall be processed (also by electronic means) solely for the purposes of the procedures pertaining to the declaration herein; that the data controller is the parks and gardens operational unit, U.O. Gestione Verde Pubblico, in the person of the director thereof; I am also aware of the provisions of art. 7 of Legislative Decree no. 196/2003 pertaining to the rights regarding access to personal data and other rights. This form, duly undersigned and scanned as a pdf file, must be sent, by e-mail only, together with a copy of the receipt attesting to the bank transfer and a copy of the ID card, to [email protected] . Place ______________________, date ____/____/____ Signature of Participant _________________________________________ .