RICHIESTA PATROCINIO Please enable JavaScript in your browser to complete this form.To: the President of the Federazione Italiana Micopatologia Umana ed Animale (FIMUA) The Undersigned *FirstLastin his/her capacity asofwith headquarters inViaPhoneEmail *Websiterequests sponsorship by the FIMUA for the following initiative (specify if event, publication, or other): entitled: Organiser’s name:SIP speakers and moderators:For this purpose, I attach:programme of eventdraft of publication File Upload Click or drag a file to this area to upload. For further information on the initiative, kindly contact: Dr/Prof. *FirstLastTel./cell.EmailPlease note that for this initiative: sponsorship by the following organisations has also been requestedsponsorship by SIF was previously obtained for the following editions yearECM certification has been requested YesNoparticipants are required to pay a registration fee of €sponsorsare presentare not presentspecify the sponsorsthe participant target is:localregionalnationalI hereby declare:that the granting of sponsorship does not involve any monetary contribution by SIFthat the granting of sponsorship involves a monetary contribution by SIF (specify amount)AmountPlace and dateSignatureClear SignatureThis request, with all appropriate documentation, must be emailed to the Organising Secretariat of FIMUA at info@fimua.eu at least 2 months before the event. Disclosure for processing of personal information. Italian Law 196/2003 protects the right to privacy of the personal information collected on this form. I hereby authorise the insertion of my information with respect to the process for the granting of sponsorship. DateSignatureClear SignatureInvia
