FACULTY ON LINE REGISTRATION FORM

 

FACULTY ON LINE REGISTRATION FORM

PERSONAL INFORMATION
Personal information are strictrly required for the CME report which we are obliged to provide to the Ministry of Health at the end of the Course.
DATE OF BIRTH  
/ /  
PLESE SPECIFY YOUR TYPE OF OCCUPATION  




ACCOMMODATION DETAILS
Hotel bookings will be made directly by the Secretariat according to your preferences expressed by this form. Accommodation expenses will be covered by the organization.
IF YES PLEASE SPECIFY:
TRAVEL
Travel organization is in charge of the participant, while transfers will be organized by the Secretariat upon request. Travel expenses will be covered by the organization and refunded after the Course by bank transfer. Please note that due to the Italian administrative rules could be refunded only the expenses sustained and demonstrated by the originals (tickets, receipts). In case of electronic tickets please remember to keep the boarding passes. The Secretariat will send the expenses claim form to be completed at the end of the Course and to be sent by post along with original receipts/tickets/invoices (from airfare, taxi, train, etc.) to the Secretariat itself.
IF YES PLEASE SPECIFY:
SOCIAL PROGRAM
In order to arrange a social program for the Faculty is kindly request to express your interest in participating to the possible following DINNERS which will be organised. A detailed social schedule will be defined according to the preferences expressed through the present form. Details will be communicated shortly before the Course.
PLEASE CONFIRM YOU WILL ATTEND THE FOLLOWING DINNERS:   Multiple selections
CME MANDATORY DOCUMENTS
PRIVACY POLICY - Informational statement according to article 13 of Legislative Decree 196/2003 (Code on protection of personal data) Information and personal data are collected through the voluntary compilation of the form and are used for the purpose of the participation at the Course. The data collected can be memorized both in electronic and paper format and will be used by us respecting all the measures provided by law for the safeguarding of the rights of the interested parties.The giving of data is optional; possible refusal to provide this data could mean the inability on our part to send the information requested and process your registation to the Course. Data will be used also with electronic devices and may be used for administrative, fiscal and/or commercial activity. We will not pas data to unauthorized third parties. Responsibility for the use of data is Consorzio Ferrara Ricerche, Via Saragat 1, 44122 Ferrara (FE). You should act for your right as stated in art. 7, by sending an e-mail to cfr@unife.it.
I HAVE READ AND AGREE WITH THE ABOVE STATEMENT  

 


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