Please fill in the following form to apply for the ExtremeSportMED honorary membership, it is free and for an indefinite period, You can revoke the membership at anytime. Step 1 of 3 33% Personal InformationsName* TitleMr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Date of Birth* DD MM YYYY Birth Place*Uniquely Identifying Code (optional)Fiscal Code / SSN / NI or equivalent Contact InformationsEmail* PhoneAddress* Street address City Province Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Additional informationEducation*High SchoolBachelor's DegreeGraduate or Professional DegreeOtherPrefer Not to AnswerAdd Curriculum Vitae*Brief ResumeStatute Acceptance* I have read and accepted the Statute and internal Regulations of the Association ExtremeSportMED Privacy Consent*By submitting your membership association application you also declare that you understand and accept the content of the association's Statute and declare that you have been informed as regards the following: 1. Data gathered by ExtremeSportMED and how it is used: * Personal data such as name and surname and/or company name, address, tax code and/or VAT number. This data is used for enrolment in in the association and is needed for the provision of all supplied services. * Contact information (email and telephone) to send out newsletters and information on activities organized by the association. * Images concerning oneself or the activities proposed and provided by the association. Such images may be used free of charge for scientific publications, posters, editorials and/or advertising, social networks and websites. 2. How, and for how long, is the information ExtremeSportMED gathers about you kept? Data may be recorded on paper or electronic media and shall be stored and protected by us in an appropriate and secure manner. In the event of non-renewal of the annual registration, personal data shall be kept for compliance with tax requirements according to law while the "contacts" shall be maintained for statistical or informative purposes or to aid resumption of provision of services should you decide to contact our organization again at a later date. The maximum term for retention of personal data is, in compliance with tax legislation, 10 years; the same period applies to "contacts" and any images. Data may be used to perform statistical analyses and sector-related studies, to assess preferences and perform profiling in order to provide services that best meet your needs. 3. Data transfer Tax data may be disclosed to the accounting firm for accounting purposes and to meet obligations related to Italian Legislative Decree 31/03/2015. Images shall not be transferred to third parties unless needed in specific projects; in this case your explicit authorization shall be requested. 4. Your data usage rights At any time you have the right, in accordance with personal data protection law, to request access to data and its correction and/or the limitation of its processing; you also have the right to oppose processing, request cancellation and/or request data portability. You also have the right to submit a complaint to a supervisory authority. To manage, modify or delete your personal data, simply contact the ExtremeSportMED Association secretariat, which shall comply with your request within 30 days. For more information on the content of the above-stated rights and how to exercise them, please contact us at email@example.com The Data Protection Officer (DPO) can be contacted at the same email address. 5. The ExtremeSportMED Data Holder is the President, Dr. Francesco Feletti By completing the procedure for registering with the Association members state they have received data handling-related information and consent to the: * Acquisition and processing of personal data for accounting purposes * Acquisition of "contacts" for promotional and service purposes * Acquisition of images/videos for scientific, editorial and/or promotional purposes * Assessment of preferences and profiling to provide a service more in line with your needs. I agree to the treatment of my personal information REGISTRATION APPLICATION, INFORMATION ON PERSONAL DATA PROCESSING AND DISCLAIMER CONCERNING IMAGES AS PER GDPR (General Data Protection Regulation, EU regulation 2016/679 art. 13) This iframe contains the logic required to handle Ajax powered Gravity Forms.