Registration form – Transforming Care Network

A. General information

Name*

First Last

Address

Street Address City County / State / Region ZIP / Postal Code Country

Passport number or Identity Card Number*

Information required in order to receive a wifi password at the Conference venue

Institutional affiliation*

Email address*

Enter Email Confirm Email

Phone number

Invoice*

A receipt of the conference payment will be provided to you at the conference desk. If you want the invoice, please select the options below (Request allowed only during this registration)

Yes
No

B. Invoice information

Please, select the options below*

Invoice issued to a physical person
Invoice issued to an Institution or other private bodies

Name*

First Last

Permanent address*

Street Address City County / State / Region ZIP / Postal Code Country

Fiscal code /VAT Id*

File*

Please upload here a copy of your ID or Passport

Name*

Address*

Street Address City County / State / Region ZIP / Postal Code Country

Fiscal code /VAT Id*

Email address*

Enter Email Confirm Email

Phone number

Codice univoco*

Indirizzo PEC*

Per fatturazione elettronica

C. Payment

Conference fees*

Conference dinner*

Yes (40,00 €)
No

Type of payment*

Merchant order number*

Please insert here the merchant order number you received by e-mail after the payment by credit card has been made (e.g. EKO_tcc17_nnnn)

File*

Please upload here the bank transfer receipt

D. Special request

(e.g. food allergies; vegetarian menu at the conference dinner, access to the conference venue, etc.)

E. Privacy policy

Dear participant, we inform you that the indication of the personal data above is compulsory. These information will be used only by the “Transforming Care Conference” and under the current Italian privacy policy. According to art.13 of D. Lgs. 196/2003 the participant can: update information; require to have outdated information removed; have the opportunity to correct any inaccuracies, or delete information. The participant can also request to remove such personal data. I authorise the processing of my personal information under D.Lgs. 196/03.

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