CEIMArs Event – ONLINE Enrollment

Name of the Event (required)

When the Event begins [e.g.: 2014-05-22] (required)

Your name (required)

Your Surname (required)

Job (required)

Telephone (required)

Fax

Email (required)

Town (required)

Country (required)

Street

ZIP

For enrollment, I paid
— via Bank Transfer MPS – IBAN: IT 68R010308 2111000000482928 (ANSPI Jasna Gora) (Swift Code: PASCITMIMER) via Bank Transfer Poste It. – IBAN: IT 67 E 07601 16600 001004989115 (CEIMArs) (Swift Code: BPPII TRR XXX) via PayPal – admin.team@ceimars.it

I know that, in the event of registration cancellation, a written notice must be sent to the Organizing Secretary at the latest by 15 days before the Event starts. If i don’t do this, 33% of my payment will be deducted from the total refund. Cancellations after this date cannot be reimbursed.

I have a right to a discount because
— 15% CEIMArs Regular Member 10% CEIMArs Sympathetic Member 10% Guarantor Institutions Member 10% Medicine Student 10% FKT or SLP Student 10% Conservatory student 10% Dance or Music or Circus or Drama Student 15% During the year 2014, I've participated to a Course linked with this PAMeC 2014

I attach:

A valid documentation in order to have the discount:

A copy of the Identity card (required):

A copy of the payment issue:

Curriculum Vitae (not compulsory):

Possible other important info (not compulsory):

By submitting this form, automatically you express consent to the processing of personal data for the purposes permitted by the Decree-Law no. 196 (30/06/2003). According to the laws, the data, which you may ask to be removed from the memoirs of CEIMArs, will never be disclosed to third parties, except where required by the Police and the Law.

Soon, You’ll receive a confirm this email arrived to Organizing Secretary.

Please, answer to this. Thanks.
1+1=? 

CEIMArs
Italian Interdisciplinary Center for Performing Arts Medicine
Centro italiano interdisciplinare di Medicina dell’Arte

via Ugo La Malfa, 46/i – 92100 Agrigento, Italy

Tax code / Codice fiscale: 93060580847

IBAN: IT 67 E 07601 16600 001004989115