nav_top

FISV 2007 .::. Personal Data Submission Form




Example entries and explanatory notes are shown below some fields.
Please see also [this] document for more details.

  Mandatory field = mandatory field
Mandatory field First name

Middle name(s)
(or initials)

e.g.,  J M P  or  J.M.P.
Mandatory field Surname
Mandatory field Affiliation

e.g.,  Dept Biomedical Sciences, Univ. Padua
Street address
(or P.O. Box)

Mandatory field City
Postal Code

State/Province

Mandatory field Country

e.g.,  IT - Please use the official ISO 3166 two-letter code, available [here].


Mandatory field Telephone
Fax:



Mandatory field E-mail
Mandatory field Confirm E-mail

e.g.,  mario.rossi@uni-pd.it - this email address is fundamental for your correct
identification and for all future contacts; please double-check that it is correct.

Mandatory field Password
Mandatory field Confirm Password

Data Protection

Having read the information regarding Italian Law D.L. 196/2003, I hereby
allow    do not allow
FISV to handle the data collected through this form.