Invitation for Honorary Members - EXTREMESPORTMED

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.

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Personal Informations
Name*
Prefix First Last
Date of Birth*

DD
MM
YYYY
Birth Place*
Uniquely Identifying Code (optional)
Fiscal Code / SSN / NI or equivalent

Contact Informations
Email*
Phone
Address*
Street address City Province Postal Code Country

Additional information
Education*
Add Curriculum Vitae*
Brief Resume
Statute Acceptance*
- I have read and accepted the Statute and internal Regulations of the Association ExtremeSportMED
Privacy Consent*
- 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)