Ecopsiché Registration Form - Ecopsiché

Yes, I want to register!

Good choice. Here is the registration form for an Ecopsychology Course or eLearning organized by Ecopsiché. After signing up, we will contact you and give you all the necessary information. Welcome!

Name*
Surname*
I'm registering for:*
- Ecocentering
- other
If "other", I specify it here:
This is my billing address: Street, Postcode, City, Country*
This is my telephone number*
This is my mail*
My motivation to participate...*
I Invoice as...*
- Private
- Freelancer or Company
Fiscal Code (National identification number - Numéro de sécurité sociale)*
VAT number (only if Freelancer or Company)
Data for the transfer (I will specify my name and the course I register for)
- Bank transfer from Italy: Marcella Eliana Danon - Iban: IT 54 B 02008 51530 000004680117
- Bank transfer from abroad: Marcella Eliana Danon - Iban: IT 54 B 02008 51530 000004680117 + Codice BIC SWIFT: UNCRITM1337
- Pay Pal: marcella.danon@ecosistemistudio.it
I have paid / will pay the fee of... on...:*
Newsletter
How did I find out about Ecopsiché and / or this course?*
Authorization to process Personal Data*
- I authorize the processing of my personal data pursuant to Italian Legislative Decree 30 June 2003, n. 196: "Code regarding the protection of personal data" . www.ecopsicologia.it/trattamento-dati-personali/.