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class="fondomenu" colspan="3" width="176"><p>&nbsp;</p></td> <td class="fondomenu"><img src="images/blank.gif" width="5" height="1" alt="" border="0"></td> <td class="separadormenu"><img src="images/blank.gif" width="1" height="51" alt="" border="0"></td> </tr> </table> </td> </tr> </table> <td> <!-- Fin de Contenido Menu --> <!-- Contenido Texto --> <td width="20"><img src="images/blank.gif" width="20" alt="" border="0"></td> <td class="contenido" width="100%" align="left" valign="top"> <p class="titulo">Nuevo socio</p> <!-- <form action="formmail2.asp" method="post" ID="Form1"> --> <form action="mailto:ans@numisans.org?subject=nuevo socio" enctype="text/plain" method="post" ID="Form1"> <!-- <input type="hidden" name="_recipients" value="jgutierrez@logiccontrol.es" ID="Hidden1"> <input type="hidden" name="_subject" value="cupón nuevo socio" ID="Hidden2"> <input type="hidden" name="_requiredFields" value="Tipo_socio,Nombre,Apellidos,Dirección,Población,Forma_pago" ID="Hidden3"> <input type="hidden" name="_redirect" value="infoseof-fin.asp" ID="Hidden4"> --> <table border="0" cellpadding="0" cellspacing="0" ID="Table3"> <tr> <td align="left" colspan="2"> <font color=red size="3">APROVECHE LA OFERTA Y HAGASE SOCIO GRATIS</font> <br> </td> </tr> <tr><td>&nbsp;</td></tr> <tr> <td align="left" colspan="2"> <font color=red size="2">Gratuidad de las cuotas de ingreso y la anual correspondiente al año 2010 de todas aquellas personas que, hasta finales de este año en curso, soliciten ser admitidos en calidad de socios. Actualmente la cuota de socio es de 40 euros anuales</font> </td> </tr> <tr><td>&nbsp;</td></tr> <tr> <td align="left" colspan="2"> <p class="titulo3">Estos son mis datos personales</p> </td> </tr> <tr> <td>&nbsp;</td> <td align="left"> <table border="0" cellpadding="3" cellspacing="0" ID="Table10"> <tr> <td align="left">Nombre:&nbsp;</td> <td align="left"> <input type="text" name="Nombre" size="60" maxlength="60" ID="Text4"> </td> </tr> <tr> <td align="left">Apellidos:&nbsp;</td> <td align="left"> <input type="text" name="Apellidos" size="60" maxlength="60" ID="Text5"> </td> </tr> <tr> <td align="left">Documento de identidad:&nbsp;</td> <td align="left"> <input type="text" name="Doc_identidad" size="15" maxlength="15" ID="Text6">&nbsp;&nbsp; (tipo:&nbsp; <input type="radio" name="Tipo_doc_identidad" checked value="NIF" style="border: none;" ID="Radio12"> NIF&nbsp; <input type="radio" name="Tipo_doc_identidad" value="tarjeta de residencia" style="border: none;" ID="Radio13"> tarjeta de residencia) </td> </tr> <tr> <td align="left" valign="top">Direcci&oacute;n:&nbsp;</td> <td align="left"> <input type="text" name="Dirección" size="60" maxlength="60" ID="Text7"><br> (completa: calle, n&uacute;mero, escalera, piso, letra) </td> </tr> <tr> <td align="left">Poblaci&oacute;n:&nbsp;</td> <td align="left"> <input type="text" name="Población" size="60" maxlength="60" ID="Text8"> </td> </tr> <tr> <td align="left">C&oacute;digo Postal:&nbsp;</td> <td align="left"> <input type="text" name="CP" size="5" maxlength="10" ID="Text9"> </td> </tr> <tr> <td align="left">Provincia:&nbsp;</td> <td align="left"> <input type="text" name="Provincia" size="60" maxlength="60" ID="Text10"> </td> </tr> <tr> <td align="left">Pais:&nbsp;</td> <td align="left"> <input type="text" name="Pais" size="60" maxlength="60" ID="Text11"> </td> </tr> <tr> <td align="left">Tel&eacute;fono:&nbsp;</td> <td align="left"> <input type="text" name="Teléfono" size="12" maxlength="12" ID="Text12"> </td> </tr> <tr> <td align="left">Direcci&oacute;n Electr&oacute;nica:&nbsp;</td> <td align="left"> <input type="text" name="EMail" size="60" maxlength="60" ID="Text13"> </td> </tr> <tr> <td align="left">Fecha de nacimiento:&nbsp;</td> <td align="left"> <input type="text" name="Fecha_nacimiento" size="12" maxlength="12" ID="Text14"> </td> </tr> <tr> <td align="left">Profesi&oacute;n:&nbsp;</td> <td align="left"> <input type="text" name="Profesión" size="60" maxlength="60" ID="Text15"> </td> </tr> <tr> <td align="left">Coleccionista de:&nbsp;</td> <td align="left"> <input type="text" name="Coleccionista_de" size="60" maxlength="60" ID="Text16"> </td> </tr> <tr> <td align="left">Presentado por:&nbsp;</td> <td align="left"> <input type="text" name="Presentado_por" size="60" maxlength="60" ID="Text17"> </td> </tr> <tr> <td align="left">&nbsp;</td> <td align="left" colspan="3"> <i>Los asociados de A.N.S. que aporten un nuevo socio recibir&aacute;n una compensaci&oacute;n como agradecimiento a su colaboraci&oacute;n.</i> </td> </tr> </table> </td> </tr> <tr> <td align="left" colspan="2"> &nbsp;<br> Solicito ser admitido en calidad de socio de n&uacute;mero<br> &nbsp; </td> </tr> <tr> <td align="left" colspan="2"> &nbsp;<br> <p class="titulo3">Forma de pago</p> </td> </tr> <tr> <td>&nbsp;</td> <td align="left"> <table border="0" cellpadding="3" cellspacing="0" ID="Table11"> <tr> <td align="left" colspan="2"> <p>Desde A.N.S. le recomendamos que env&iacute;e sus datos por correo electr&oacute;nico mediante este formulario. Si domicilia el pago, por favor, no olvide dar autorizaci&oacute;n de pago a su banco o caja. Gracias.</p> <br> <p>Tambi&eacute;n puede enviarnos sus datos mediante fax, correo postal o llamarnos al 93 725 85 16.</p> </td> </tr> <tr> <td align="left"> <input type="radio" name="Forma_pago" value="domiciliación bancaria" checked style="border: none;" ID="Radio14">&nbsp; </td> <td align="left"> <b>Domiciliaci&oacute;n bancaria</b> </td> </tr> <tr> <td align="left">&nbsp;</td> <td align="left"> <table border="0" cellpadding="3" cellspacing="0" ID="Table4"> <tr> <td align="left" colspan="4"> (recomendada por ser la m&aacute;s c&oacute;moda para usted y para nosotros, y la que menos gastos genera) </td> </tr> <tr> <td align="left">Caja/Banco:&nbsp;</td> <td align="left"> <input type="text" name="Banco" size="25" maxlength="40" ID="Text16">&nbsp;&nbsp; </td> <td align="left">CCC:&nbsp;</td> <td align="left"> <input type="text" name="CCC_ban" size="4" maxlength="4" ID="Text17">&nbsp; <input type="text" name="CCC_suc" size="4" maxlength="4" ID="Text18">&nbsp; <input type="text" name="CCC_dc" size="2" maxlength="2" ID="Text19">&nbsp; <input type="text" name="CCC_nro" size="12" maxlength="10" ID="Text20"> </td> <td align="left" width="20%">&nbsp;</td> </tr> <tr> <td align="left"> Dirección sucursal:&nbsp; </td> <td align="left" colspan="3"> <input type="text" name="Direccion_sucursal" size="60" maxlength="60" ID="Text21"> </td> </tr> <tr> <td align="left"> Titular:&nbsp; </td> <td align="left" colspan="3"> <input type="text" name="CCC_Titular" size="60" maxlength="60" ID="Text22"> </td> </tr> <tr> <td align="left" colspan="3"> <i>Muy Sr. m&iacute;o, s&iacute;rvase cargar a la cuenta arriba indicada y hasta nueva orden los recibos presentados por A.N.S. en concepto de cuota anual de socio.</i> </td> <td align="left" valign="top">&nbsp;&nbsp;Firma:</td> </tr> </table> </td> </tr> <tr> <td align="left"> <input type="radio" name="Forma_pago" value="giro postal" style="border: none;" ID="Radio15">&nbsp; </td> <td align="left"><b>Giro postal</b> (adjunto justificante)</td> </tr> <tr> <td align="left"> <input type="radio" name="Forma_pago" value="cheque" style="border: none;" ID="Radio16">&nbsp; </td> <td align="left"><b>Cheque</b> (a nombre de A.N.S.)</td> </tr> <tr> <td align="left"> <input type="radio" name="Forma_pago" value="tarjeta" style="border: none;" ID="Radio17">&nbsp; </td> <td align="left"><b>Transferencia a: A.N.S. al Banco de Sabadell, 0081 - 0195 - 70 - 0001087215</b></td> </tr> </table> </td> </tr> <tr> <td align="left" colspan="2"> &nbsp;<br> Sus datos personales se incorporar&aacute;n a un fichero automatizado de A.N.S. con el fin de mantenerle informado sobre nuestras actividades. Le garantizamos que estos datos ser&aacute;n tratados de forma confidencial y ser&aacute;n de uso exclusivo de A.N.S.. Si lo desea, puede acceder, rectificar o cancelar sus datos dirigiendo un escrito a A.N.S., C/San Jaime, 4B - 08201 Sabadell (Barcelona)<br> &nbsp; </td> </tr> <tr> <td align="center" colspan="2"> &nbsp;<br> <input type="submit" value="Enviar" ID="Submit1" NAME="Submit1"> &nbsp;&nbsp; <input type="Reset" value="Borrar" ID="Reset1" NAME="Reset1"> </td> </tr> </table> </form> <!-- <script type="text/javascript"> document.Form1.Nombre.focus(); </script> --> <p>&nbsp;</p> </td> <!-- Fin de Contenido Texto --> </tr> </table> </td> </tr> <!-- Fin de Contenido --> <!-- Pie --> <tr> <td height="25" colspan="3" valign="top"> <table align="left" width="100%" height="25" cellpadding="0" cellspacing="0" style="MARGIN: 0px 1px 0px 0px" ID="Table12"> <tr> <td height="1" colspan="3" class="carpetaseparador"><img src="images/blank.gif" width="1" height="1" alt="" border="0"></td> </tr> <tr> <td align="center" valign="middle" class="info"> Email: <a href="mailto:info@numisans.org?subject=Consulta" class="webmaster">Asociación Numismática Sabadell </a> </td> </tr> </table> </td> </tr> <!-- Fin de Pie --> </table> </body> </html>