From: Subject: Date: Fri, 17 Oct 2008 23:31:56 +0200 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0000_01C930B0.8B56D1F0" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.5579 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C930B0.8B56D1F0 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: file://C:\Documents and Settings\Domenico\Documenti\gruppo sportivo\moduli interni\modulo iscrizione gsd.htm

3D"Logo

Modulo di iscrizione al Gruppo = Sportivo=20 Dilettantistico Non Vedenti Milano ONLUS

Cognome: Nome:

Comune di nascita: Prov.: () Data di nascita:

Comune di = Residenza:=20 = Prov.:=20 ()=20 Cap:

Indirizzo: n.:

Tel. = Abitazione:=20 Tel.=20 Ufficio: =20

Cellulare: =20 E-mail: =20

Tipo Doc. Identit=E0: Nr.: Rilasciato il:

Codice = Fiscale: = Disabile: Disabile S=EC Disabile No
Il sottoscritto = chiede=20 l=92iscrizione al Gruppo Sportivo Dilettantistico Non Vedenti Milano = ONLUS=20 accettandone lo Statuto, il Regolamento e le disposizioni
di volta in = volta=20 impartite.Il sottoscritto, consapevole delle responsabilit=E0 e delle = pene=20 stabilite dalla legge per le false attestazioni e mendaci=20 dichiarazioni,
sotto la propria responsabilit=E0 dichiara che i dati = sopra=20 riportati sono veritieri (art. 26 L. 15/68).

Data: =        = ;            =         =20 Firma=20 leggibile
        &n= bsp;           &nb= sp;           &nbs= p;            = ;      =20 (In caso di minorenne, Firma di chi esercita la patria=20 potest=E0)

        &nb= sp;           &nbs= p;            = ;            =    =20 _________________________________________________

Trat= tamento=20 Dati Personali
Ai sensi dell=92art. 3 L. 196/2003 = recante =93Tutela=20 delle persone e di altri soggetti rispetto al trattamento dei dati = personali =94=20 DICHIARA di aver preso conoscenza
di tale normativa ed in particolare = l=92art.=20 10 della stessa legge e di conferire al Gruppo Sportivo Dilettantistico = Non=20 Vedenti Milano ONLUS il proprio consenso
per il trattamento dei dati=20 personali e sensibili nell=92ambito delle finalit=E0 e con modalit=E0 = ivi=20 indicate.

Data:       &nbs= p;            = ;    =20 Firma=20 leggibile
        &n= bsp;           &nb= sp;           &nbs= p;            = ;      =20 (In caso di minorenne, Firma di chi esercita la patria=20 potest=E0)

        &nb= sp;           &nbs= p;            = ;            =    =20 _________________________________________________

Gruppo Sportivo Dilettantistico Non = Vedenti Milano=20 ONLUS
c/o Istituto dei Ciechi - Via Vivaio, 7 - 20122 = Milano
Tel./Fax:=20 0276004839 - email: info@gsdnonvedentimilano.org= =20 Sito web: http://www.gsdnonvedentimilano.= org/
Codice=20 Fiscale: 97063940155
IBAN: IT57 R033 5901 = 6001 0000=20 0004 341

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