REGISTRATION FORM “INTERNAL POWER JOURNEY”

REGISTRATION FORM “INTERNAL POWER JOURNEY”

NAME_______________________________SURNAME________________________________

ADRESS_______________________N°____________________CITY__________________

COUNTRY _________________ ZIP ________________________PHONE_________________________

CELL___________________________email___________________________________________

PLEASE INDICATE THE AMOUNT OF THE BANK TRANSFER_____________________

NOTES__________________________________________________________________________

SIGNATURE ___________________ RECEIVED AND ACCEPTED ___________________

In compliance with the italian Legislative Decree n. 196 date 30/06/2003, I hereby authorize the recipient of this registration form to use and process my personal data for the purpose of organizing my participation at the event INTERNAL POWER JOURNEY and I confirm to be informed of my rights in accordance to the art7 of the above mentioned decree.

signature ___________________