Become member of A.A.R.B.A., eng

First name*
Middle name
Last name*
Date of birth*

MeseGiornoAnno
Place of birth*
Qualification
Academic specialization
e.g. engineering; psychology; etc..
Master/PhD or other post-lauream studies
Current employment*
Employer (Firm/Institution)*
Nationality*
Address*
City*
State*
ZIP code*
E-Mail*
Phone (Business)*
Phone (Personal)
Fields of interest*

ClinicalEducationalOccupational psychologyMedicineResearch methodologiesBehavior-Based Safety
Member type*

Active member (€120)Ordinary member (€80)Affiliated member (€50)Independent backer (€100)
Personal info of the invoice holder

If the invoice holder data differs from the ones entered above
Business name or full name
Address
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Send your CV (.doc or .pdf) whether you have chosen Active or Ordinary member (max 50kb, otherwise send a e-mail to segreteria@aarba.it)

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I declare that I have read and understood the obligations arising from the registration and i will satisfy the characteristics of the member profile chosen*

Yes
I authorize the treatment of my personal data according to Dlgs 196/2003 and I authorize AARBA sending me information about initiatives related to the association activities*

Yes
Bank details for the payment of the membership fee:
Cariparma Ag. 8 Milano Via Mussi Giuseppe, 4
IT 57 O 06230 01657 000043266702
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Personal info of the invoice holder