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$Our Society \ Membership \ Online subscription form :: Sivim | Italian Society of Medical Virology$

Online subscription form

Please, fill in the following form in order to send your subscription request to SIVIM.
Subscriptions will be confirmed either per email or telephone by SIVIM’s Administrative Offices after receiving the related membership fee payments, which must be provided according to the terms indicated in the Subscription page. All fields are mandatory.

PERSONAL DATA Name
Surname
Place of birth
Date of birth

Title
Affiliation

City of residence
Street N.
Zip code Country

Telephone
Fax
Email

SUBSCRIPTION DETAILS I have read the Association statute and I ask for a subscription as:

Supporting MemberFree contribution (minimum € 500,00)
Ordinary Member€ 15,00
StudentFree

Subscription renewal€ 15,00

I want to receive "The New Microbiologica" magazine for the current year (€ 30,00)

I give my consent

PRIVACY NOTICE Privacy statement according to art. 13 of Italian Law n. 196/2003
(Italian Law for the protection of personal data)

According to the Italian Legislative Decree n. 196/2003, SIVIM will handle any personal data provided only for the purposes of carrying out the activities related to the organization and management of the meetings and courses you will take part in. Your data will be safely stored in our system and disclosed to third parties for the aforementioned purposes only.

According to art. 7 of the Italian Legislative Decree n. 196/2003, the data subject shall have the right to ask for the rectification or cancellation of his/her personal data to the person entitled to the collection and handling of the personal data within the Italian Society of Medical Virology.

I have read the privacy statement and I give my consent to the treatment of my personal data for the purposes indicated in the notice.

I give my consent

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SIVIM Società Italiana di Virologia Medica
c/o Università "La Sapienza", Dipartimento di Medicina Sperimentale e Patologia, Sezione Virologia
Viale di Porta Tiburtina, 28 - 00185 Roma - Tel. +39.064474121 - Fax. +39.0644741236 - Email: segreteria.virologia@uniroma1.it