PERSONAL DATA

Please fill in all the required fields on the form and check them before sending. Remember that the name and surnames you provide on this form will be the ones we use on your diploma.

First name and Surname (required)

Email (required)

Postal address (required)

NIF/CIF (Spanish nationals only), NIE or Passport number (required)

City (required)

Post code (required)

Province (required)

Telephone number (required)

PRICES

Please select the appropriate price:
I am a Clinical Associate of SIODEC (365 €)I am a General Member of SIODEC (435 €)I am not a member of SIODEC (585 €)

BOOK A PLACE

Booking is required. The booking fee is €50 and is included in the total cost of the course. After completing the registration form you will access a page showing three different payment options: the booking fee to secure your place; the booking fee plus the remaining amount owing for the course; the remaining amount owing for the course (if you have already paid the booking fee). You can make these payments by bank card (using the payment gateway), by bank transfer or by PayPal. If you choose to pay by bank transfer, you will be required to send proof of payment by e-mail to info@siodec.org.

Please indicate below the payment option you have chosen:
Booking onlyBooking + remaining amountRemaining amount (this field only to be used if the booking has already been made and paid for)

PROGRAMME

SIODEC is very environmentally friendly and as such, each participant will receive the course programme as a pdf document. You may also receive a printed version if you wish. Which format would you like to receive the programme in?

Format:
PDF onlyPDF + printed copy

PAYMENT

Please indicate below how you wish to pay:
Bank transferBank cardPayPal

INVOICE

Please indicate if you require an invoice:
YesNo

TAX INFORMATION

Only complete this section if you require an invoice to be made out to another entity/person:

First name

Surname

NIF/CIF (Spanish nationals only), NIE or Passport number

Postal address

City

Province

Post code

DATA PROTECTION ACT

In accordance with the provisions of the Organic Law of Personal Data Protection 15/1999 of 13th December, I hereby give consent for my details to be included on a file held by SIODEC (International Society of Developmental and Behavioural Optometry), for the purpose of communicating with its members and other parties interested in registering for and participating in, the activities it organizes. I also declare that I have been informed of the rights of access, correction, cancellation and opposition that I may exercise at SIODEC’s registered address in Calle Guillem de Castro, Nº 44 Entresuelo, ES46001 Valencia (Spain), by sending a written communication accompanied by proof of identity (Identity card, NIE or passport), or by sending an email to info@siodec.org, with the heading “Data Protection Act” in the subject line of the message.

I agree:
YesNo

I hereby authorise my personal details be disclosed to SIODEC for the express purpose of creating a registration form and of drawing up the corresponding diploma given to participants.

I agree: YesNo

I declare I have been informed about the confidential nature of the documents I will be given during the course I am attending and understand that I am not authorised to share the contents or use them as the basis for any other course or training session beyond SIODEC.

I agree:
YesNo

During the course, individual and/or group photographs or short video clips will be uploaded to the web (www.siodec.org) and /or to SIODEC’s social networks (Facebook and Twitter). In compliance with the provisions of the aforementioned Organic Law, I agree to appear in the group photos and /or short video clips which may be published on the SIODEC website and /or the entity’s social networks and that I may exercise my rights of access, rectification, cancellation and opposition by sending a letter accompanied by proof of my identity (Identity card, NIE or passport) to SIODEC’s registered address in Calle Guillem de Castro, Nº 44 Entresuelo, ES46001 Valencia (Spain) or by email to info@siodec.org.

I agree:
YesNo