Please complete the following form to register for “Maximizing Sports Performance: Behavioral Optometric Evaluation and Sports Vision Enhancement Training” course. Please note that after completing the questionnaire and pressing “SEND” you will receive an email at the address you supplied, with a link for you to complete your purchase. If you want to use our payment platform to process your payment, please click here. 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 firstname.lastname@example.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 email@example.com, 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 firstname.lastname@example.org. I agree: YesNo Once you have registered and pressed “SEND”, you will receive an email with a link to finalize your purchase. If you do not receive the link, please click here.