ego.evsrl.it - Richiesta di iscrizione / Registration Request

To sign in to EGO, please fill in the form below and click ok "Send request". You will receive your username and password via e-mail within 2 working days. Fields marked with an asterisk (*) are required.

Plase note: If you are a member or you were a member of SCIVAC, SIVAR, SIVE, SIVAL, AIVEMP, SIVAL or of a related specialist association, or if you participated in an event organized by EV Soc. cons. a r.l., you don't need to sign in; please use the password recovery page instead. You will receive your username and password immediately.

Personal data

Salutation *

First name *

Family name *

Gender *

Birth date (dd/mm/yyyy) *

Birth place *

Fiscal Code (Italians only)

VAT Code

Here I state, under my own responsibility, that :

I am a member of the Italian "Ordine Dei Medici Veterinari" of

since *

membership number *

I am a neo-graduated in Veterinary Medicine - University name *

graduation year *

I am a graduated in Veterinary Medicine - University name *

graduation year *

I am a student in Veterinary Medicine - University name *

first registration year *

I am a graduated in an analogous discipline (please specify) *

I want to fill in:

My personal address form

My work address form

Both my address forms

Private address

Country *	Street address *
	Postal code *	City / Town *	Province *

Phone

Fax

Mobile

E-mail *

Work address

Country *	Clinic / Company / University *
	Department / Sector
	Address *
	Postal code *	City / Town *	Region *

Phone

Fax

E-mail *

I want communications to be sent at:

my personal address

my work address

Under the Legislative Decree of 30 June 2003, n. 196 (GU July 29, 2003, General Series No. 174, ordinary supplement No 123 / L), I hereby agree to the processing of data above, aware that the execution of the required services cannot take place without the disclosure of personal data to EV Soc. cons. a r.l. - Via Trecchi 20, Cremona, Italy and / or subject to which it must contact.

I accept the above policy

			Registration Request
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