Terme di Sirmione


PERSONAL DATA
*All sections marked with an must completed**
* Name:
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Sex:	Male Femal
Birth Date:	/ /
* Address:
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Fax:
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* Structure:
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* Data of medical examination	/ /
* Time:
Notes:
By filling in this form, I accept the treatment of my personal data according to the Italian law on Data Protection (No. 675 of 31/12/96). At any time it will be possible for me to have access to my own data, and to ask for them to be modified or cancelled.
Info lt. Art. 10 Gesetz 675/96
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