Reclami

SCHEDA PER RECLAMI, SUGGERIMENTI ED ELOGI

RECLAMO        O                               SUGGERIMENTO       O                                      ELOGIO        O

 

Cognome _____________________________________

Nome ___________________________________

Residente in via __________________________________________

n° ______________

Comune ____________________________________________

Provincia ____________________

Telefono _________________________

E-mail ________________________________________________

segnalo quanto segue:

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Io sottoscritto, ai sensi della Legge 196/03 concernente la tutela delle persone e di altri soggetti rispetto al trattamento dei dati personali, fornisco il mio consenso a che codesta Associazione tratti i miei dati personali, generici e sensibili, ai fini della gestione del contenuto della presente scheda.

Data _________________                                             Firma _______________________________

 

PARTE RISERVATA ALL’ASSOCIAZIONE:

Scheda ricevuta:

Direttamente                         O

Telefonicamente                 O

Posta ordinaria                    O

Fax                                            O

E-mail                                      O

Altro (specificare) ____________________________________

 

Data _________________                              Firma operatore __________________________

 

AZIONI INTRAPPRESE:

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