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Rimini - 8/10 Giugno 2012 - Nuovo Centro Congressi

MODULO D’ISCRIZIONE SESSIONI LIBERE COGNOME: .................................................................................................

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CODICE FISCALE:

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E-MAIL: ....................................................................................................... SOCIO SCIVAC

❐ SI

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❐ Studente in Medicina Veterinaria ❐ Laureato in Medicina Veterinaria DATA: ........................................................................................................... FIRMA: ......................................................................................................... PRIVACY Ai sensi del decreto legislativo 30 giugno 2003, n. 196 (G.U. 29 luglio 2003, Serie generale n. 174, Supplemento ordinario n. 123/L), il sottoscritto acconsente al trattamento dei dati sopra indicati, consapevole che l’esecuzione dei servizi richiesti non può avere luogo senza le comunicazioni dei dati personali all’ANMVI e/o ai soggetti a cui la stessa deve rivolgersi.

FIRMA …………………...……...……...……...……...……...……...……...……...……...…


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