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 __________