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User Profile
Informative Note
Do you agree to the processing of your identification and/or sensitive personal data by DOUBLE EM SRL, according to the ways and for the purposes specified in the privacy statement?

 
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Privacy Policy DOUBLE EM
 

 
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Personal details and nationality
Title *
Name * Last name *
Gender * Date of birth *  (dd/mm/yyyy)
Country of birth *
Province/State *
Place of Birth
Place of Birth *
Fiscal Code (or any code that allows you to identify yourself on an invoice) *
Tax code
(or any other type of ID) assigned by the State in which you are established, domiciled or resident
V.A.T. (Value Added Tax)
Residence or Contact details
Country of residence *
Province/State *
Province/State
City *
City *
 Address *
Zip code *
Telephone (+XXXXXX) *
Telephone (+XXXXXX)
Fax Mobile (+XXXXXX)
Email *
 I'm not ask the awarding of Italian CME credits
 I ask the awarding of Italian CME credits
Profession and Specialization
I will participate to this event as a listener or as a trainee
I ask the awarding of Italian CME credits
Occupational status *
Profession *
Specialization *
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Other personal information
OTHER (specify in the notes on the following page)
FISHETARIAN
GLUTEN FREE
NO LATTOSIO
VEGAN
VEGETARIAN

* Required
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