International Partner Odontologist AIOM

I have an existing account I am a new user

The undersigned hereby requests registration/renew the registration for the year 2020 for Accademia Italiana di Odontoiatria Microscopica. Pursuant to and for the purpose of the Law of January 4, 1968 no. 15 and of the DPR 445/2000 and subsequent amendments and additions, the undersigned, who is aware of its responsibilities and penalties established by the law concerning misrepresentations and false statements, on its own responsibility (art. 26 L.04/01/1968; art. 76 DPR 445/2000 and subsequent amendments)

Title

Place of birth

Date of birth

Fiscal code (mandatory):

Registration number in the register of odontologists

Province of registration in the register:

Registration number in the register of dental hygienists

with the Order TSRM PSTRP of

Tel

Fax

Mobile Phone Number

Certifiede-mail:

Business name:

Address

Zip Code

City

Country

State

Username:

First Name:

Last Name:

Password (twice):

Enter your desired password twice. Must be at least 8 characters long.

I agree to the Terms of Service

I authorize the processing of my personal data pursuant to EU Reg. 679/2016. Before proceeding read ours Privacy Policy

Selezionando questa casella confermi di aver letto e accettato i Termini di servizio.

Selezionando questa casella accetti di ricevere ulteriori informazioni riguardanti i nostri prodotti / servizi, eventi, novità e offerte.