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Return your application form by mail after the signature

APPLICATION FOR ADMISSION TO THE ASSOCIATION AND ACTIVITIES OF THE “POLICASTRO BUSSENTINO PROJECT 2014”

Name:Surname:

Nationality:

Date of Birth:Gender:

Place of birth:

Permanent Address:

Postcode:

E-Mail:

Telephone Number:

What are thedates chosenfor the excavation?

1. General health:

  1. Possible food allergies:
  1. Possible allergies to medicines:
  1. Possible allergies to environmental factors:
  1. Chronic illnesses:
  1. Brief resume of current medication:
  1. Any dietary requirements:

2. Previous archaeological experience

  1. Are you an archaeology student?YESNO
  2. At which University? Year of study?
  3. Previous experience of excavation/fieldwork (please specify where; how long; and in what role(s):

3. Language

10. Do you speak any languages (other than English)? If so, which ones?

4. Placement

11. Where did you find out about the placement?

5. Interests

12. In which activities are you most interested?

Data Protection Details

Following legal requirements (of Art. 13 of Decree 196/2003) the following information is provided:

1. The information you have provided is guaranteed be used exclusively in relation to activities connected with the Associazione Etruria Nova Onlus;

2. Information given in writing may be recorded on paper and digitally;

3. To guarantee your privacy, information is stored with adequate security to prevent any unauthorized access by third parties;

4. The provision of this information is a condition of involvement in the activities of the Associazione Etruria Nova Onlus;

5. The information given will not be broadcast, or communicated to other organizations;

6. Following Art. 7 of Decree 196/2003, you may exercise the right at any time to contact the data administrators of Associazione Etruria Nova Onlus. In particular you may request confirmation of, or as a minimum, confirmation of the existence of information pertaining to you, its content and origin. You may check its veracity and accuracy, and request additions, updates or corrections. You have the right to request the removal or blocking of information used in violation of the law, in addition to raising objections, in the case of legal use, to the manner of such use. If you request the removal of such information, you will no longer be able to use the services of the Association.

Signature

Consent in accordance with Article 23 of Decree 196/2003

I consent, in accordance with Art. 23 of D.L. 196/2003, to the use of information provided as detailed above.

I authorize the taking of photographic images for publicity purposes in print and in digital forms, in the publication of information about the activities of the Associazione Etruria Nova Onlus.

Date

Signature

AssociazioneEtruria NovaOnlus - Vicolo S. Agostino, 12–53024, Montalcino (SI); CF 9417354048.

Sito:

Contatti: email. ; Cell. 349 3613406