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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)


Email (required)

Town (required)

Country (required)



For enrollment, I paid

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

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.

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