Abilita JavaScript nel browser per completare questo modulo.To: the President of MicrobiotaMI association The Undersigned *NomeCognomein his/her capacity asofwith headquarters inViaPhoneEmail *Websiterequests sponsorship by the MIcorbiotaMI 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 Fai clic o trascina il file su quest'area per caricarlo. For further information on the initiative, kindly contact: Dr/Prof. *NomeCognomeTel./cell.EmailPlease note that for this initiative: sponsorship by the following organisations has also been requestedsponsorship by MicrobiotaMI 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 MicrobiotaMIthat the granting of sponsorship involves a monetary contribution by MicrobiotaMI (specify amount)AmountPlace and dateSignaturePulisci la firmaThis request, with all appropriate documentation, must be emailed to the Organising Secretariat of MicrobiotaMI at info@simif.it 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. DateSignaturePulisci la firmaInvia
