APPLICATION FORM 2017
AIQUA Fall School
PERSONAL DETAILS
Title (Mr/Miss/Mrs/Ms/Dr): …….
Family/last name: …………………………………………………………………………
First name(s): ……………………………………………………………………………….
Gender: Male /Female
Address for correspondence: …………………………………..
Country: …………………………………………………..
Email address: …………………………………..
(We will email booking/payment confirmation and relevant information to this email address. Please, keep us update of any change)
Telephone number: ……………………………….
Date of birth: DD/MM/YYYY
Nationality (as per your passport): ………………
AIQUA member (No/Yes):………………………..
SPECIAL REQUIREMENTS
Do you have any special physical or medical requirements? No / Yes
…………………………………………………………………………………………
If yes, we will contact you for further details.
ACCOMODATION
Please state if you need a single room………………………………………..
If you share a room please write here the name of the person you share the room with
………………………………………………………………………………………..
ACADEMIC AND PROFESSIONAL DETAILS
Please give details of your educational background, including current study and degrees achieved:
[_] Studying for PhD
[_] PhD
[_] Other graduate programme
[_] Other
Please give details of your status: Student | Employed | Retired | Academic | Other - Profession: ……
EMERGENCY CONTACT DETAILS
Please give details of someone we can contact in case of emergency while you are attending the school:
Name: …………………………………………………………………………………………………………
Telephone number: …………………………..
Email address: …………………………………
ATTACHEMENTS
Please attach to your application:
- Copy of a valid identity document, signed and legible (I.D. card – Passport);
- information about the presentation of your own research (details about abstract and presentation form)
I agree that I meet the requirements, that the information on this application form is true at the time of writing and I have read this form. Applications cannot be accepted without a signature.
Date Signature of the candidate
Annex 2 – Consent to use personal data
Information in accordance with the D.Lgs 196/2003 – Code on personal data
Purposes of the processing
In accordance with the section 13 D.lgs. n.196/2003 the provided data will be processed in the necessary measure and for the purposes connected to the enrollment and the attendance to the training course.
Methods of processing and subjects involved
The processing will be done both manually and by computer. The data may be communicated to institutions or public and private authorities if strictly necessary for the scope of the teaching activities of the course.
Nature of the provision of the data and consequences of a potential refusal
The provision of the data is mandatory, and the potential refusal of the provision involves the impossibility of the enrollment in the course and the management of the connected procedural activities, as well as the teaching activities.
Holder and supervisor of the processing
The holder of the processing of the data is the AIQUA – Associazione Italiana per il Quaternario represented in person by its pro tempore legal representative, the president Maria Rita Palombo.
Section 7 d.lgs. 196/2003 - Right to Access Personal Data and Other Rights
- The data subject shall have the right to be informed
a) of the source of the personal data;
b) of the purposes and methods of the processing;
c) of the logic applied to the processing, if the latter is carried out with the help of electronic means;
d) of the identification data concerning data controller, data processors and the representative designated as per section 5 paragraph 2;
e) of the entities or categories of entity to whom or which the personal data may be communicated and who or which may get to know said data in their capacity as designated representative(s) in the State’s territory, data processor(s) or person(s) in charge of the processing.
- The subject shall have the right to obtain
a) updating, rectification or, where interested therein, integration of the data;
b) erasure, anonymizing or blocking of data that have been processed unlawfully, including data whose retention is unnecessary for the purposes for which they have been collected or subsequently processed;
c) certification to the effect that the operations as per letters a) and b) have been notified, as also related to their contents, to the entities to whom or which the data were communicated or disseminated, unless this requirement proves impossible or involves a manifestly disproportionate effort compared with the right that is to be protected.
- The subject shall have the right to object, in whole or in part,
a) on legitimate grounds, to the processing of personal data concerning him/her, even though they are relevant to the purpose of the collection;
b) to the processing of personal data concerning him/her, where it is carried out for the purpose of sending advertising materials or direct selling or else for the performance of market or commercial communication surveys.
Signature for acceptance
Please email your fully completed application form in PDF/scanned version no later than July 29, 2017 hrs 12 AM UTC/GMT to:
Summer School Coordinators, Dr. Biagio Giaccio – Dr. Ilaria Mazzini
Istituto di geologia ambientale e geoingegneria - CNR
For any enquiry or further information, please call
Ph. +39 0690672750
Once you have been notified the acceptance to the AIQUA fall school you need to pay the fee by September 2, 2017 to confirm your attendance.