International School on "In Silico Trials"

REGISTRATION FORM

*: required. Non Italian subscribers can enter the value 000000 in the field "Tax Code"
Mr.Ms.
Family name * (Cognome / Nom de famille / Nachname / Appellidos)	First name * (Nome / Prénom / Vorname / Nombre)
Tax code * (Codice fiscale / Code des impost / Abgabenordnung / Código fiscal)
Place of birth (Luogo di nascita / Lieu de naissance / Geburtsort / Lugar de nacimiento)	Date of birth -YYYY MM DD- (Data di nascita -AAAA MM GG- / Date de naissance / Datum der Geburt / Fecha de Nacimiento)
Occupation - dealing (Professione / Profession / Geschäft / Profesión)
Address * (Indirizzo / Adresse / Anschrift / Dirección)
City * Città / Ville / Stadt / Ciudad)	Zip code * (Codice postale / Code postal / Postcode / Código postal)
State / province or district * (Provincia / État / Land / Estado o provincia)
Country * (Paese / Pays / Staat / País)
Tel.	Fax
E-mail *

REGISTRATION FEE

	description	amount
1)	members of For profit organisations	1500,00 euro
2)	members of No profit organisations	750,00 euro
3)	VPHi members (www.vph-institute.org)	500,00 euro
4)	Avicenna Alliance members	1100,00 euro

description

amount

Note

members of For profit organisations

1500,00 euro

members of No profit organisations

750,00 euro

VPHi members (www.vph-institute.org)

500,00 euro

Avicenna Alliance members

1100,00 euro

select your registration fee *

Grand total :

PRIVACY POLICY

The Owner of the data handled is Fondazione Alma Mater, with seat in Bologna (Via delle Belle Arti 42, 40126, Bologna, Italy). The personal information provided by the addressee will also be processed by means of automated-based systems, for the purposes indicated in the present application form and in the forms concerning the participation to the course. The relevant person has the right to be given access by Fondazione Alma Mater to any data that pertain to them and may exercise the right for the data to be supplemented, corrected, updated, etc, as guaranteed under artt. 15, 16, 17, 18, 19, 20, 21, 22 Information and access to personal data, Rectification and erasure and Right to object and automated individual decision-making of the General Data Protection Regulation and art. 7 of the Decree Law n° 196/2003. Although the conferment of data and agreement regarding the processing thereof is optional, these steps do constitute the necessary conditions for the performance of the above described activities. Refusal to give permission may mean that Fondazione Alma Mater will not be able to accept the application. The addressee grants his/her own permission for his/her personal data to be processed by ticking off the option "accept".

Accept *

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On line payment

FOR INQUIRIES ABOUT REGISTRATION, PLEASE CONTACT THE ADMINISTRATIVE STAFF (comunicazione@fondazionealmamater.it).

The registration fee may be paid by bank transfer: account payable to Fondazione Alma Mater, UniCredit Banca P.zza Aldrovandi, IBAN IT 41T0200802457000020123112, BIC/SWIFT UNCRITM1PM7.

Please specify name and surname of the participant and the description of payment (e.g. "Course of..."; "International Conference in..."; "Summer School...").

Bank charges are for the participant's account.