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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