Test Fields with an asterisk * are required. Personal Information for Participants Title * ProfDrMrMs Last (Family) Name * First (Given) Name * Present Nationality * Date of birth. Field required if you need our free Medical Insurance which is necessary for visa application. Place of birth Gender * MF Affiliation Qualification MAIL ADDRESS * HomeOffice Address * Zip Code * City * State and/or Country * Phone (e.g. +39 0663...) Mobile (e.g. +39 349...) Email * The URL of your web page (if available) How did you hear about the Isodarco Courses? Announcement received by email Printed poster that I have received by mail From posters displayed. Where? From a printed advertisement. Where? From a friend, colleague or family member: please indicate her/his name if possible From the Isodarco website From another website From a search engine I have already participated in other courses Isodarco Other (please specify) Comments Do you need a visa to come to Italy? YesNo Where would you apply for visa? (if possible indicate the Email and full address of the Italian Consular Office where you will apply) EDUCATION HIGH SCHOOL DEGREE Degree in * Institution * Year * UNIVERSITY DEGREE Degree In Institution Title of the thesis Year OTHER UNIVERSITY DEGREE Degree In Institution Title of the thesis Year OTHER DEGREES Past and Present Professional Activities (Curriculum) and Work Address Publication list or Letter of Recommendation Fields of Interest Indicate if you apply for a reduced fee and why If you wish to present a seminar or show a film or organize a spontaneous activity provide the title and a short description of your proposal or fill the form Extra Activity and deliver it to the course secretariat at Andalo. Notes By clicking “Send”, you express your consent to the processing of your data provided in this registration form, under the legal information provided in the “LEGAL INFORMATION PAGE” of the ISODARCO web site (www.isodarco.it), in compliance with the laws and regulations in force (Art. 13 and 14 of EU Regulation 2016/679).