docmodulo accredito stampa / press accreditation form
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modulo accredito stampa / press accreditation form
Salone dell’Emergenza - Emergency Exhibition Centro Fiera di Montichiari, Italy | October 10 - 12, 2014 www.reasonline.it MODULO ACCREDITO STAMPA / PRESS ACCREDITATION FORM Da restituire debitamente compilato via fax al numero 030 9961966 o via email all’indirizzo [email protected] To return properly filled by fax +39 030 9961966 or by email at [email protected] DATI PERSONALI / PERSONAL DATA Cognome / Last Name ........................................................................................................................................................................... Nome / Name ....................................................................................................................................................................................... Indirizzo / Address ....................................................................................................................... Cap / ZIP Code ............................... Località / Town ............................................................................................................................ Prov. / State .................................... Tel. / Phone ........................................................................................ Fax ............................................................................................ Cell. / Mobile .................................................................................... E-mail ...................................................................................... Iscritto all’ordine dei giornalisti di ................................................ Tessera n. .................................................................................. ATTIVITÀ PROFESSIONALE / PROFESSIONAL ACTIVITY A) B) Stampa / Press Rivista, Giornale / Magazine, Newspaper Stampa online / Online press Settimanale / Weekly TV e radio / TV and radio Fotografo / Photographer Quotidiano / Daily Altro / Other Mensile / Monthly Altro / Other TESTATA / MEDIA ................................................................................................................................................................................... Indirizzo Professionale (se diverso dal Precedente) / Professional Address (if different from above): Indirizzo / Address ....................................................................................................................... Cap / ZIP Code ............................... Località / Town ............................................................................................................................. Prov. / State .................................... Tel. / Phone ........................................................................................ Fax ............................................................................................ Cell. / Mobile .................................................................................... E-mail ...................................................................................... Consenso al trattamento dei dati personali I dati vengono raccolti in base D.Lgs. 196/2003 e trattati manualmente e/o elettronicamente a fini statistici e di marketing per l’aggiornamento sulle iniziative di Centro Fiera S.p.A. con invio di materiale informativo anche tramite terzi. Inoltre, tali dati potranno essere utilizzati dal Centro Fiera S.p.A. per l’eventuale pubblicazione del catalogo della manifestazione. In relazione all’informativa fornitaci ai sensi del D.Lgs. 196/2003, la sottoscritta Ditta esprime il proprio consenso al trattamento dei dati. Consent to data processing The data will be collected according to D.Lgs. 196/2003 Such data will be proccessed manually and/or electronically for the following purposes: statistics, marketing and updating on the initiatives of Centro Fiera S.p.A. by sending out informative amterial even via third parties. Furthermore, said data will be use for the pubblication of the official exhibition catalogue. I authorise the processing and the communication of my data as mentioned above in accordance with D.Lgs. 196/2003. The undersigned company expresses its concent to processing the data. Data / Date ............................................... Firma / Signature .................................................................. CENTRO FIERA S.p.A. - Via Brescia, 129 - 25018 Montichiari (BS) - Tel +39 030 961148 - Fax +39 030 9961966 - [email protected] - www.centrofiera.it - www.reasonline.it
