Surname, first name

Email address (to contact you on the use of your testimonial)

Oui

I would like my testimonial to remain anonymous.

You are:

You can write your testimony below:

If you authorise the use of your image exclusively in the context of your testimonial, please attach your photo (max file of 5 MB).

Authorisation:
I hereby confirm that I have read the legal notice below and I authorise the publication and use of my testimonial exclusively for the project also described in the legal notice below.


Legal notice - Click to read

Project:

To introduce micro-immunotherapy to interested parties and support them in their therapeutic approach. The aim is therefore to publish and translate written testimonies with or without a photograph of the person in question (patient or doctor) who used micro-immunotherapy, on the documents, web pages and social networks of the Micro-immunotherapy International Medical Experience (www.micro-immunotherapy.com), the Institut Français de Micro-immunothérapie (www.microimmuno.fr), the Asociación Española de Microinmunoterapia (www.aemi.es) and the Medizinische Gesellschaft für Mikroimmuntherapie (www.megemit.org).

Your rights:

You may exercise your rights to access, rectification, objection, erasure, portability and restriction of processing with the beneficiaries by email to micro-immunotherapy@micro-immunotherapy.com. The beneficiaries shall endeavour to take all reasonable steps to erase or rectify any inaccurate personal data.

Beneficiaries:

1) Institut Français de Micro-immunothérapie (IFMi): 18 rue Georges Clémenceau, 85700 POUZAUGES, France – Siret (French business number): 433 413 531 00040

2) Asociación Española de Microinmunoterapia (AEMI): Avenida Portal de l’Angel 36, 08002 BARCELONA, Spain – CIF: G64420797

3) Medizinische Gesellschaft für Mikroimmuntherapie (MeGeMIT): Operngasse 17-21, 1040 VIENNA, Austria – VAT No.: ATU68398067

Medium: Internet or hardcopy (worldwide)

Duration: 15 years

The beneficiaries will exercise all of the exploitation rights attached to your testimony and picture. The beneficiaries may translate your testimony or have it translated into any language. The testimony and all translations shall remain the exclusive property of the beneficiary. The latter shall expressly refrain from transferring these authorisations to third parties.

The beneficiaries shall also refrain from the illicit exploitation or exploitation outside the above authorisation of your written testimony and picture, which may adversely affect your dignity, reputation or private life, and any other prejudicial exploitation according to the laws and regulations in force.

In the context outlined above, the collection and use of your written testimony and picture shall not give rise to any remuneration or consideration in any form whatsoever.  This express acceptance is final and precludes any request for subsequent remuneration.

In accordance with European Regulation EU-2016/679 of 27/04/2016, the beneficiaries shall undertake to comply with the General Data Protection Regulation (GDPR), which came into force on 25 May 2018.

The personal data shall be stored on a computerised medium and integrated into the processing system under the beneficiary’s responsibility for the entire duration of this Authorisation and also for a period of two years after termination of the latter in order to ensure the correct implementation of the said Authorisation and to comply with legal obligations.

The beneficiaries shall undertake to process the data in a legal, reliable, transparent, appropriate, relevant, limited, precise and up-to-date manner.