Surname(s):

Name:

Company:

Telephone:

Fax:

E-mail:

Query:

We hereby inform you that, in order to comply with Organic Statute 15/1999, dated 13 December, on the Protection of Personal Data, the data you have just provided must appear in our computer files for their correct registration and administration.

Please check this box if you do not wish to receive publicity from us.

Should there be any changes to the personal data given above, please let us know.

Based on said organic statute, you have every right to access, correct and strike the data by writing to Dr Astrid Dorfmeister, Plaza de Bonanova, Nr. 4 , 6º-2ª, (08022 Barcelona) or by sending an e-mail to consulting@astriddorfmeister.com