Personal data First name * Surname * Academic Title * ---Professor EmeritusProfessorPhDMDMD, PhDPhD studentTrainee E-mail * Country * ArubaAfghanistanAngolaAnguillaÅland IslandsAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntarcticaFrench Southern TerritoriesAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBonaire, Sint Eustatius and SabaBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaSaint BarthélemyBelarusBelizeBermudaBolivia, Plurinational State ofBrazilBarbadosBrunei DarussalamBhutanBouvet IslandBotswanaCentral African RepublicCanadaCocos (Keeling) IslandsSwitzerlandChileChinaCôte d'IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCuraçaoChristmas IslandCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaWestern SaharaSpainEstoniaEthiopiaFinlandFijiFalkland Islands (Malvinas)FranceFaroe IslandsMicronesia, Federated States ofGabonUnited KingdomGeorgiaGuernseyGhanaGibraltarGuineaGuadeloupeGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGreenlandGuatemalaFrench GuianaGuamGuyanaHong KongHeard Island and McDonald IslandsHondurasCroatiaHaitiHungaryIndonesiaIsle of ManIndiaBritish Indian Ocean TerritoryIrelandIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJerseyJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, Republic ofKuwaitLao People's Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMacaoSaint Martin (French part)MoroccoMonacoMoldova, Republic ofMadagascarMaldivesMexicoMarshall IslandsMacedonia, the former Yugoslav Republic ofMaliMaltaMyanmarMontenegroMongoliaNorthern Mariana IslandsMozambiqueMauritaniaMontserratMartiniqueMauritiusMalawiMalaysiaMayotteNamibiaNew CaledoniaNigerNorfolk IslandNigeriaNicaraguaNiueNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPitcairnPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People's Republic ofPortugalParaguayPalestine, State ofFrench PolynesiaQatarRéunionRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSouth Georgia and the South Sandwich IslandsSaint Helena, Ascension and Tristan da CunhaSvalbard and Jan MayenSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSaint Pierre and MiquelonSerbiaSouth SudanSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSint Maarten (Dutch part)SeychellesSyrian Arab RepublicTurks and Caicos IslandsChadTogoThailandTajikistanTokelauTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUnited States Minor Outlying IslandsUruguayUnited StatesUzbekistanHoly See (Vatican City State)Saint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, BritishVirgin Islands, U.S.Viet NamVanuatuWallis and FutunaSamoaYemenSouth AfricaZambiaZimbabwe Fiscal code (only for italians) * Date of birth (for non italians) * Professional data Institution * Address * City * Zip code * Web page Research field * Attached brief Curriculum Vitae * Member categories Individual or Corporate Corporate - 200 euroActive - 50 euro (scientists and clinicians working in any field related to mitochondria and paying an active membership fee)Patients association - 50 euroJunior - 25 euro (undergraduate students above 18 years of age, PhD students, clinicians in training and postdocs)Senior - 25 euro (previous active members after their retirement from full-time academic or clinical employment) Information and request for consent for the processing of personal data We invite you to sign the following declaration: I, the undersigned person, I authorize E-mit, with headquarters in Via del Rastrello, 7- 53100 Siena, (hereinafter, "Owner"), as data controller, in agreement with art. 13 Legislative Decree 6/30/2003 n. 196 (hereinafter, "Privacy Code") and art. 13 EU Regulation no. 2016/679 (hereinafter, "GDPR") to process my data in the manner and for the following purposes: processing both by means of computerized and/or telematic tools, and manually for purposes connected and/or instrumental to the SienaCongress association activity, as foreseen and regulated by current national and/or community legislation in force; in particular: - to make it possible the execution of the associative, administrative and legal obligations envisaged - to make it possible to carry out the task assigned or fulfill the contractual obligations assumed. In the event that the performance of the assigned assignment or the contractual fulfillment obligations provides for the interest and/or activity of third parties, such as companies and/or professionals, subject to your authorization, your data will be communicated to individual managers, who will operate as data controllers for the processing of data connected to the part of their competence or: - to make it possible the execution of the foreseen administrative and legal obligations - to make it possible to carry out the task assigned or fulfill the contractual obligations assumed This authorization may be revoked by you at any time with written communication according to the methods found in the information on the site I confirm that I have read and agree with the E-Mito data protection policy. I consent to receive notifications regarding the payment of membership fees, notices for the General Meeting and other communications related to E-Mito.