Attestato Corso 1° Livello

APPLICATION FORM 2002

TO ENROL IN THE COURSE/S, FILL IN THIS FORM IN DETAIL LEAVING NO BLANK SPACES. SPECIFY THE COURSE/S WHICH EACH PERSON SHOULD BE ENROLLED IN BY CHECKING THE CORRESPONDING BOX.

COMPANY DATA

Corporate Name

Road

Postal Code

Town

Telephone number

Fax

In this part, type in the name of the person/s to enrol. Indicate which course/s they wish to attend by checking the appropriate box/es under the name of each person.

Surname

Christian name

Profession or qualification

1^st and 2^nd DIVISION - 1^s^t level for the installation of polymer bitumen membranes and heat insulation

1^st and 2^nd DIVISION - 2^nd level for the installation of polymer bitumen membranes and heat insulation

3^rd DIVISION - course for the refurbishment of asbestos cement

4^th DIVISION - course for the restoration of humid building work, the waterproofing of underground rooms or tanks and concrete rebuilding work

5^th DIVISION - course for laying floors and coatings

Surname

Christian name

Profession or qualification

1^st and 2^nd DIVISION - 1^s^t level for the installation of polymer bitumen membranes and heat insulation

1^st and 2^nd DIVISION - 2^nd level for the installation of polymer bitumen membranes and heat insulation

3^rd DIVISION - course for the refurbishment of asbestos cement

4^th DIVISION - course for the restoration of humid building work, the waterproofing of underground rooms or tanks and concrete rebuilding work

5^th DIVISION - course for laying floors and coatings

Surname

Christian name

Profession or qualification

1^st and 2^nd DIVISION -1^s^t level for the installation of polymer bitumen membranes and heat insulation

1^st and 2^nd DIVISION - 2^nd level for the installation of polymer bitumen membranes and heat insulation

3^rd DIVISION - course for the refurbishment of asbestos cement

4^th DIVISION - course for the restoration of humid building work, the waterproofing of underground rooms or tanks and concrete rebuilding work

5^th DIVISION - course for laying floors and coatings

Surname

Christian name

Profession or qualification

1^st and 2^nd DIVISION -1^s^t level for the installation of polymer bitumen membranes and heat insulation

1^st and 2^nd DIVISION - 2^nd level for the installation of polymer bitumen membranes and heat insulation

3^rd DIVISION - course for the refurbishment of asbestos cement

4^th DIVISION - course for the restoration of humid building work, the waterproofing of underground rooms or tanks and concrete rebuilding work

5^th DIVISION - course for laying floors and coatings

Surname

Christian name

Profession or qualification

	1^st and 2^nd DIVISION -1^s^t level for the installation of polymer bitumen membranes and heat insulation
	1^st and 2^nd DIVISION - 2^nd level for the installation of polymer bitumen membranes and heat insulation
	3^rd DIVISION - course for the refurbishment of asbestos cement
	4^th DIVISION - course for the restoration of humid building work, the waterproofing of underground rooms or tanks and concrete rebuilding work
	5^th DIVISION - course for laying floors and coatings

I acknowledge that my personal data and that of my company, contained in the present application form, will be stored by INDEX in their data-bank in order to send any informative, advertising or promotional material, in accordance with art. 2, Coma 1, Letter f of Law 675/96. At any time I may ask for my data to be modified, not used or cancelled, in accordance with art. 13 of the same Law by writing to INDEX, Via G. Rossini n.22, 37060, Verona, Italy.

For any further information or queries, please phone: 045/8546201