Spett. CSPPNI S.r.l.

Centro Studi di Psicomotricità Psicologia

e Neuropsichiatria Infantile

Viale Marche n. 93

20159 Milano

P.Iva - C.F. - C.C.I.A.A. 04447170962

SERVICE PROVIDED TO PROFESSIONALS AND TO CHILD-RELATED FIGURES

My name is ____________________________________________________________________________

I was born in ________________________________________________ on ________________________________

I live in ______________________________________________________________________________

I am the author of the article / paper / research / case history: _______________________________________________________________________________________

I grant permission to

CSPPNI S.r.l. - Centro Studi di Psicomotricità Psicologia e Neuropsichiatria Infantile – registered office in Milano Viale Marche n. 93 - P.IVA 04447170962

To publish and broadcast over the internet (from the website www.csppni.it) the above mentioned article/paper/research/case history which I attach to this letter (title of article here)

I also declare

• That I effectively waive any economic right towards CSPPNI S.r.l. regarding the above mentioned text;
• That I am the actual author of the text or, at any rate, that I have received an authorisation and a mandate from a co-author or other assignees pertaining to the present authorisation and declaration;
• That sensitive data pertaining to individuals mentioned in the text is not linked to actual means of identification. Notwithstanding, if such data appears, it is because of direct permission from the concerned party who acquiesced to its utilization for scientific and informative purposes;
• That the contents of the text are in no way of a political or religious nature;
• That the contents relate to a scientific pursuit;

I accept and acknowledge the fact that

• Broadcasting of the above mentioned text over the internet on the website www.csppni.it may last indefinitely and rests entirely on CSPPNI S.r.l. ‘s discretion, who may also terminate it at any time or even decide not to start it;
• The text will be part of a database;
• CSPPNI S.r.l. will attend to always mention the author of the text, who may state by writing any restrictions concerning broadcasting and reproduction of the same;
• Registered users (infantile neuropsychiatrists, psychologists, psychomotor and neuropsychomotor specialists, rehabilitation therapists, speech therapists, pedagogists and educationists) of the website www.csppni.it will always be free to consult the same for learning, scientific or therapeutic purposes;
• Broadcasting over the internet does not give the author any right of recourse against other website users or CSPPNI S.r.l. users;
• CSPPNI S.r.l. is not responsible for the truthfulness of the text and for any other effect it may cause.

CSPPNI S.r.l. strives to provide a service for child-related figures such as: infantile neuropsychiatrists, psychologists, psychomotor and neuropsychomotor specialists, rehabilitation therapists, speech therapists, pedagogists and educationists.

In good faith

Date Signature

Attachments

Please return duly signed by fax 02/69017600 or by mail