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Name* |
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Last name* |
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| Email* |
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| Weight (KG)* |
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Height (cm)* |
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| Practiced sport activity |
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| Other activity |
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| level |
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Nr. of week trainings |
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| training Period |
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| Have you already used on owned electrostimulator? |
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| Objective to reach* |
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| Free time per week for electrostimulation |
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| Model of the owned electrostimulator* |
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| Other model |
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| Device code (S.N. on the back of the device)* |
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| Further useful details: |
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Riscrivere sotto i caratteri dell'immagine sopra distinguendo tra maiuscolo e minuscolo
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*obligatory fields
The data which have been sent through the application form will be treated within the meaning of art. 13 of the D. lgs. n. 196/2003, therefhours:
1. Given data will be only treated to carry out the request for a training table.
2. The treatment of the data will be mode an informatic mode.
3. The data asset is obbligatory only for the fields marked by the asterik, which are needed to answer the request in the best way.
4. The data will not be further communicated nor spread. |
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