Adesione Causa contro i Tamponi

Nome*

CognomeNome

Nato il *

GiornoMeseAnno

Nato a*

Codice Fiscale*

Inserire un codice fiscale valido (in MAIUSCOLO)

Residenza/Domicilio*

Via e n.civico

Indirizzo Riga 2

Città e Provincia (in sigla)Nazione

Codice Postale

Indirizzo Mail*

Inserire un indirizzo mail valido

Numero di Telefono*

Si prega di inserire un numero di telefono valido con il prefisso nazionale (per Italia +39).

Caricare Documento (Carta ID, Passaporto, Patente..)*

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Caricare Codice Fiscale/Tessera Sanitaria (fronte e retro)*

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Caricare Mandato Firmato (Procura)*

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Caricare Informativa Privacy Firmata*

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Caricare Contabile del Bonifico

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