{"id":4458,"date":"2020-12-08T17:41:40","date_gmt":"2020-12-08T16:41:40","guid":{"rendered":"http:\/\/sindacatomedicitaliani.it\/?page_id=4458"},"modified":"2023-10-22T12:52:38","modified_gmt":"2023-10-22T10:52:38","slug":"pre-iscrizione-sindacato-medici-italiani","status":"publish","type":"page","link":"https:\/\/sindacatomedicitaliani.it\/index.php\/pre-iscrizione-sindacato-medici-italiani\/","title":{"rendered":"Pre Iscrizione Sindacato Medici Italiani"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4458\" class=\"elementor elementor-4458\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4c2055a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4c2055a\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a97ff26\" data-id=\"a97ff26\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e1bb4f2 elementor-widget elementor-widget-text-editor\" data-id=\"e1bb4f2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<h2><strong>Form di Iscrizione<br>Sindacato dei Medici Italiani<\/strong><\/h2>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ec09fef elementor-align-center elementor-widget elementor-widget-button\" data-id=\"ec09fef\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"mailto:web@sindacatomedicitaliani.it\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Fai clic qui se hai bisogno di supporto<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fb82643 elementor-widget elementor-widget-shortcode\" data-id=\"fb82643\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-3466\"><form id=\"wpforms-form-3466\" class=\"wpforms-validate wpforms-form\" data-formid=\"3466\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/4458?wpforms_form_id=3466\" data-token=\"543cb5e950f51484a0938f6e42f00ccc\" data-token-time=\"1777534625\"><noscript class=\"wpforms-error-noscript\">Abilita JavaScript nel browser per completare questo modulo.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#72b239\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">Passo <span class=\"wpforms-page-indicator-steps-current\">1<\/span> di 4<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:25%;background-color:#72b239\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-3466-field_61-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"61\"><\/div><div id=\"wpforms-3466-field_17-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"17\"><h3 id=\"wpforms-3466-field_17\">Sezione A) Riferimento Stato Professionale<\/h3><\/div><div id=\"wpforms-3466-field_18-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"18\"><\/div><div id=\"wpforms-3466-field_109-container\" class=\"wpforms-field wpforms-field-hidden wpforms-one-third wpforms-first\" data-field-id=\"109\"><input type=\"hidden\" id=\"wpforms-3466-field_109\" name=\"wpforms[fields][109]\" value=\"30\/04\/2026\"><\/div><div id=\"wpforms-3466-field_45-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-first wpforms-one-fourth wpforms-one-third wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"45\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_45\">Stato Professionale <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-3466-field_45\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][45]\" required=\"required\"><option value=\"Dirigenza Medica\" >Dirigenza Medica<\/option><option value=\"Medico Convenzionato\" >Medico Convenzionato<\/option><option value=\"Medico INPS\" >Medico INPS<\/option><option value=\"Medico in Formazione\" >Medico in Formazione<\/option><option value=\"Libero Professionista\" >Libero Professionista<\/option><option value=\"Pensionato\" >Pensionato<\/option><option value=\"Medicina Penitenziaria\" >Medicina Penitenziaria<\/option><\/select><\/div><div id=\"wpforms-3466-field_5-container\" class=\"wpforms-field wpforms-field-select wpforms-one-third wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"5\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_5\">Regione <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-3466-field_5\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][5]\" required=\"required\"><option value=\"ABRUZZO\" >ABRUZZO<\/option><option value=\"BASILICATA\" >BASILICATA<\/option><option value=\"CALABRIA\" >CALABRIA<\/option><option value=\"CAMPANIA\" >CAMPANIA<\/option><option value=\"EMILIA ROMAGNA\" >EMILIA ROMAGNA<\/option><option value=\"FRIULI VENEZIA GIULIA\" >FRIULI VENEZIA GIULIA<\/option><option value=\"LAZIO\" >LAZIO<\/option><option value=\"LIGURIA\" >LIGURIA<\/option><option value=\"LOMBARDIA\" >LOMBARDIA<\/option><option value=\"MARCHE\" >MARCHE<\/option><option value=\"MOLISE\" >MOLISE<\/option><option value=\"PIEMONTE\" >PIEMONTE<\/option><option value=\"PUGLIA\" >PUGLIA<\/option><option value=\"SARDEGNA\" >SARDEGNA<\/option><option value=\"SICILIA\" >SICILIA<\/option><option value=\"TOSCANA\" >TOSCANA<\/option><option value=\"TRENTINO ALTO ADIGE\" >TRENTINO ALTO ADIGE<\/option><option value=\"UMBRIA\" >UMBRIA<\/option><option value=\"VALLE D&#039;AOSTA\" >VALLE D&#039;AOSTA<\/option><option value=\"VENETO\" >VENETO<\/option><\/select><\/div><div id=\"wpforms-3466-field_32-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"32\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_32\">Settore <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-3466-field_32\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][32]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Selezionare Settore<\/option><option value=\"Assistenza Primaria\" >Assistenza Primaria<\/option><option value=\"Continuita&#039; Assistenziale\" >Continuita&#039; Assistenziale<\/option><option value=\"Emergenza Sanitaria Territoriale 118\" >Emergenza Sanitaria Territoriale 118<\/option><option value=\"Pediatria di Libera Scelta\" >Pediatria di Libera Scelta<\/option><option value=\"Medicina dei Servizi\" >Medicina dei Servizi<\/option><option value=\"Specialistica Ambulatoriale\" >Specialistica Ambulatoriale<\/option><\/select><\/div><div id=\"wpforms-3466-field_121-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"121\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_121\">Ex Sias <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-3466-field_121\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][121]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Selezionare Ex Sias<\/option><option value=\"Si\" >Si<\/option><option value=\"No\" >No<\/option><\/select><\/div><div id=\"wpforms-3466-field_122-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"122\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_122\">Ex Sias - Si - Settore <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-3466-field_122\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][122]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Selezionare Settore<\/option><option value=\"Assistenza Primaria\" >Assistenza Primaria<\/option><option value=\"Medicina dei Servizi\" >Medicina dei Servizi<\/option><option value=\"Guardia Medica\" >Guardia Medica<\/option><option value=\"Emergenza Territoriale\" >Emergenza Territoriale<\/option><\/select><\/div><div id=\"wpforms-3466-field_123-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"123\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_123\">Ex Sias - No - Settore <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-3466-field_123\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][123]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Selezionare Settore<\/option><option value=\"Medicina Penitenziaria Convenzionata\" >Medicina Penitenziaria Convenzionata<\/option><\/select><\/div><div id=\"wpforms-3466-field_2-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"2\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_2\">Tipologia Azienda - Dirigenza <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-3466-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Selezionare Tipologia Azienda<\/option><option value=\"A.U.S.L.\" >A.U.S.L.<\/option><option value=\"Az. Ospedaliera\" >Az. Ospedaliera<\/option><option value=\"Universit\u00e0\" >Universit\u00e0<\/option><option value=\"118 e Pronto Soccorso\" >118 e Pronto Soccorso<\/option><\/select><\/div><div id=\"wpforms-3466-field_46-container\" class=\"wpforms-field wpforms-field-select wpforms-one-half wpforms-first wpforms-one-fourth wpforms-one-third wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"46\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_46\">Ospedale - Territorio <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-3466-field_46\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][46]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Selezionare Ospedale - Territorio<\/option><option value=\"Ospedale\" >Ospedale<\/option><option value=\"Territorio\" >Territorio<\/option><\/select><\/div><div id=\"wpforms-3466-field_4-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-one-fourth wpforms-two-thirds wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"4\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_4\">Ospedale <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-3466-field_50-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"50\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_50\">Azienda <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_50\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][50]\" required><\/div><div id=\"wpforms-3466-field_49-container\" class=\"wpforms-field wpforms-field-text wpforms-one-half wpforms-one-fourth wpforms-two-thirds wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"49\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_49\">Azienda \/ Distretto <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_49\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][49]\" required><\/div><div id=\"wpforms-3466-field_48-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-first wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"48\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_48\">Azienda \/ Distretto <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_48\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][48]\" required><\/div><div id=\"wpforms-3466-field_56-container\" class=\"wpforms-field wpforms-field-select wpforms-one-third wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"56\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_56\">Regione <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-3466-field_56\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][56]\" required=\"required\"><option value=\"ABRUZZO\" >ABRUZZO<\/option><option value=\"BASILICATA\" >BASILICATA<\/option><option value=\"CALABRIA\" >CALABRIA<\/option><option value=\"CAMPANIA\" >CAMPANIA<\/option><option value=\"EMILIA ROMAGNA\" >EMILIA ROMAGNA<\/option><option value=\"FRIULI VENEZIA GIULIA\" >FRIULI VENEZIA GIULIA<\/option><option value=\"LAZIO\" >LAZIO<\/option><option value=\"LIGURIA\" >LIGURIA<\/option><option value=\"LOMBARDIA\" >LOMBARDIA<\/option><option value=\"MARCHE\" >MARCHE<\/option><option value=\"MOLISE\" >MOLISE<\/option><option value=\"PIEMONTE\" >PIEMONTE<\/option><option value=\"PUGLIA\" >PUGLIA<\/option><option value=\"SARDEGNA\" >SARDEGNA<\/option><option value=\"SICILIA\" >SICILIA<\/option><option value=\"TOSCANA\" >TOSCANA<\/option><option value=\"TRENTINO ALTO ADIGE\" >TRENTINO ALTO ADIGE<\/option><option value=\"UMBRIA\" >UMBRIA<\/option><option value=\"VALLE D&#039;AOSTA\" >VALLE D&#039;AOSTA<\/option><option value=\"VENETO\" >VENETO<\/option><\/select><\/div><div id=\"wpforms-3466-field_51-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"51\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_51\">Centro Medico Legale INPS <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_51\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][51]\" required><\/div><div id=\"wpforms-3466-field_65-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"65\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_65\">Eventuale Specializzazione In:<\/label><input type=\"text\" id=\"wpforms-3466-field_65\" class=\"wpforms-field-large\" name=\"wpforms[fields][65]\" ><\/div><div id=\"wpforms-3466-field_52-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"52\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_52\">Indirizzo <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_52\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][52]\" required><\/div><div id=\"wpforms-3466-field_53-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"53\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_53\">Cap <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_53\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][53]\" required><\/div><div id=\"wpforms-3466-field_54-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"54\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_54\">Citt\u00e0 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_54\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][54]\" required><\/div><div id=\"wpforms-3466-field_55-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"55\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_55\">Provincia <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_55\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][55]\" required><\/div><div id=\"wpforms-3466-field_6-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"6\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_6\">Previdenza <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-3466-field_6\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][6]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Selezionare Previdenza<\/option><option value=\"ENPAM\" >ENPAM<\/option><option value=\"INPS\" >INPS<\/option><\/select><\/div><div id=\"wpforms-3466-field_47-container\" class=\"wpforms-field wpforms-field-select wpforms-one-third wpforms-one-fourth wpforms-conditional-field wpforms-conditional-show wpforms-field-select-style-classic\" data-field-id=\"47\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_47\">Previdenza <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-3466-field_47\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][47]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Selezionare Previdenza<\/option><option value=\"ENPAM\" >ENPAM<\/option><\/select><\/div><div id=\"wpforms-3466-field_20-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"20\"><\/div><div id=\"wpforms-3466-field_21-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"21\"><\/div><div id=\"wpforms-3466-field_60-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"60\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"3466\" disabled>Successivo<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-3466-field_16-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"16\"><h3 id=\"wpforms-3466-field_16\">Sezione B) Dati Anagrafici<\/h3><\/div><div id=\"wpforms-3466-field_19-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"19\"><\/div><div id=\"wpforms-3466-field_10-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_10\">Io Sottoscritto <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-3466-field_10\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][10][first]\" required><label for=\"wpforms-3466-field_10\" class=\"wpforms-field-sublabel after \">Nome<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3466-field_10-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][10][last]\" required><label for=\"wpforms-3466-field_10-last\" class=\"wpforms-field-sublabel after \">Cognome<\/label><\/div><\/div><\/div><div id=\"wpforms-3466-field_34-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_34\">Codice Fiscale <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_34\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][34]\" required><\/div><div id=\"wpforms-3466-field_11-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-firstwpforms-one-half wpforms-first\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_11\">Nato a: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_11\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][11]\" required><\/div><div id=\"wpforms-3466-field_13-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_13\">Provincia: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_13\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][13]\" required><\/div><div id=\"wpforms-3466-field_12-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-thirdwpforms-one-half wpforms-one-third\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_12\">Data: <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-large\"><select name=\"wpforms[fields][12][date][d]\" id=\"wpforms-3466-field_12-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>GG<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][12][date][m]\" id=\"wpforms-3466-field_12-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][12][date][y]\" id=\"wpforms-3466-field_12-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>AAAA<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/div><div id=\"wpforms-3466-field_14-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-first\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_14\">Residente a: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_14\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][14]\" required><\/div><div id=\"wpforms-3466-field_88-container\" class=\"wpforms-field wpforms-field-text wpforms-one-fourth wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"88\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_88\">Indirizzo di Residenza (A questo Indirizzo Verr\u00e0 Spedita la Tessera SMI Servizi) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_88\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][88]\" required><\/div><div id=\"wpforms-3466-field_22-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_22\">Cap: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_22\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][22]\" required><\/div><div id=\"wpforms-3466-field_23-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_23\">Provincia Residenza: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_23\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][23]\" required><\/div><div id=\"wpforms-3466-field_24-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_24\">Recapito Telefonico:<\/label><input type=\"tel\" id=\"wpforms-3466-field_24\" class=\"wpforms-field-medium wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][24]\" ><\/div><div id=\"wpforms-3466-field_25-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_25\">Recapito Cellulare: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-3466-field_25\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][25]\" required><\/div><div id=\"wpforms-3466-field_26-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_26\">Indirizzo Email: <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-3466-field_26\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][26][primary]\" spellcheck=\"false\" required><label for=\"wpforms-3466-field_26\" class=\"wpforms-field-sublabel after \">Email<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-3466-field_26-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-3466-field_26\" name=\"wpforms[fields][26][secondary]\" spellcheck=\"false\" required><label for=\"wpforms-3466-field_26-secondary\" class=\"wpforms-field-sublabel after \">Conferma email<\/label><\/div><\/div><\/div><div id=\"wpforms-3466-field_27-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"27\"><\/div><div id=\"wpforms-3466-field_28-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"28\"><\/div><div id=\"wpforms-3466-field_63-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"63\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"2\" data-formid=\"3466\" disabled>Successivo<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-3466-field_29-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"29\" style=\"display:none;\"><h3 id=\"wpforms-3466-field_29\">Sezione C) Tipologia di Contratto <\/h3><\/div><div id=\"wpforms-3466-field_69-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"69\" style=\"display:none;\"><h3 id=\"wpforms-3466-field_69\">Sezione C) Allegare Copia Documento di Identit\u00e0<\/h3><\/div><div id=\"wpforms-3466-field_30-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"30\" style=\"display:none;\"><\/div><div id=\"wpforms-3466-field_33-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-hide wpforms-field-select-style-classic\" data-field-id=\"33\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_33\">Contratto (Indicare il tipo di contratto)<\/label><select id=\"wpforms-3466-field_33\" class=\"wpforms-field-medium\" name=\"wpforms[fields][33]\"><option value=\"A Tempo Indeterminato\" >A Tempo Indeterminato<\/option><option value=\"A Tempo Determinato\" >A Tempo Determinato<\/option><option value=\"Medico in Formazione\" >Medico in Formazione<\/option><\/select><\/div><div id=\"wpforms-3466-field_35-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_35\">Allega Documento di Identit\u00e0 <span class=\"wpforms-required-label\">*<\/span><\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"35\"\n\t\tdata-form-id=\"3466\"\n\t\tdata-input-name=\"wpforms_3466_35\"\n\t\tdata-extensions=\"jpg,pdf,doc,docx\"\n\t\tdata-max-size=\"8388608\"\n\t\tdata-max-file-number=\"2\"\n\t\tdata-post-max-size=\"8388608\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Fai clic o trascina i file su quest&#039;area per caricarli.<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">Puoi caricare fino a 2 file.<\/span>\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-3466-field_35\"\n\t\tname=\"wpforms_3466_35\" required\t\tvalue=\"\">\n<\/div><div id=\"wpforms-3466-field_36-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"36\"><\/div><div id=\"wpforms-3466-field_37-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"37\"><\/div><div id=\"wpforms-3466-field_64-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"64\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"3\" data-formid=\"3466\" disabled>Successivo<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4 last \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-3466-field_38-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"38\" style=\"display:none;\"><h3 id=\"wpforms-3466-field_38\">Sezione D) Autorizzazione Privacy e Firma<\/h3><\/div><div id=\"wpforms-3466-field_70-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"70\" style=\"display:none;\"><h3 id=\"wpforms-3466-field_70\">Sezione D) Autorizzazione Versamento in Favore dello SMI<\/h3><\/div><div id=\"wpforms-3466-field_79-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"79\"><\/div><div id=\"wpforms-3466-field_71-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"71\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_71\">Spett.le Banca <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_71\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][71]\" required><\/div><div id=\"wpforms-3466-field_72-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"72\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_72\">Agenzia Sede <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_72\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][72]\" required><\/div><div id=\"wpforms-3466-field_73-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"73\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_73\">Indirizzo Agenzia <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_73\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][73]\" required><\/div><div id=\"wpforms-3466-field_74-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"74\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_74\">Cap <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_74\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][74]\" required><\/div><div id=\"wpforms-3466-field_75-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"75\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_75\">Citt\u00e0 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_75\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][75]\" required><\/div><div id=\"wpforms-3466-field_76-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"76\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_76\">Provincia <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_76\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][76]\" required><\/div><div id=\"wpforms-3466-field_77-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-first wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"77\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_77\">Conto Corrente Numero <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_77\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][77]\" required><\/div><div id=\"wpforms-3466-field_78-container\" class=\"wpforms-field wpforms-field-text wpforms-one-third wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"78\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_78\">Intestato a: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3466-field_78\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][78]\" required><\/div><div id=\"wpforms-3466-field_82-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"82\"><\/div><div id=\"wpforms-3466-field_87-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"87\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_87\">Accesso ai Servizi ed alle Convenzioni previste dalla Tessera &quot;SMI Servizi&quot; <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3466-field_87\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3466-field_87_1\" name=\"wpforms[fields][87][]\" value=\"Dichiaro di prestare il consenso alla sottoscrizione della tessera &quot;SMI Servizi&quot; per poter avere accesso ai Servizi ed alle Convezioni previste per gli iscritti al costo di Euro 10,00 Una Tantum da saldare a mezzo Bonifico Bancario sul c\/c Poste Italiane con cod. IBAN IT31C0760103800000067373548 intestato a: Sindacato Medici Italiani oppure tramite pagamento elettronico Paypal con modalit\u00e0 che verranno comunicate dopo la convalida dell&#039;iscrizione.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3466-field_87_1\">Dichiaro di prestare il consenso alla sottoscrizione della tessera \"SMI Servizi\" per poter avere accesso ai Servizi ed alle Convezioni previste per gli iscritti al costo di Euro 10,00 Una Tantum da saldare a mezzo Bonifico Bancario sul c\/c Poste Italiane con cod. IBAN IT31C0760103800000067373548 intestato a: Sindacato Medici Italiani oppure tramite pagamento elettronico Paypal con modalit\u00e0 che verranno comunicate dopo la convalida dell'iscrizione.<\/label><\/li><\/ul><\/div><div id=\"wpforms-3466-field_80-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"80\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_80\">Autorizzazione Versamento in Favore dello SMI <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3466-field_80\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3466-field_80_1\" name=\"wpforms[fields][80][]\" value=\"Chiedo alla suddetta banca di effettuare per mio conto la seguente disposizione di pagamento permanente in favore di S.M.I., Sindacato dei Medici Italiani, Via Livorno, 36 00162 Roma, a mezzo Bonifico Bancario sul c\/c Poste Italiane con cod. IBAN IT31C0760103800000067373548 intestato a: Sindacato Medici Italiani, secondo la seguente modalit\u00e0 (indicare di seguito la forma di pagamento preferita):\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3466-field_80_1\">Chiedo alla suddetta banca di effettuare per mio conto la seguente disposizione di pagamento permanente in favore di S.M.I., Sindacato dei Medici Italiani, Via Livorno, 36 00162 Roma, a mezzo Bonifico Bancario sul c\/c Poste Italiane con cod. IBAN IT31C0760103800000067373548 intestato a: Sindacato Medici Italiani, secondo la seguente modalit\u00e0 (indicare di seguito la forma di pagamento preferita):<\/label><\/li><\/ul><\/div><div id=\"wpforms-3466-field_81-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"81\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_81\">Scelta della Forma di Pagamento <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3466-field_81\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3466-field_81_1\" name=\"wpforms[fields][81][]\" value=\"Versamento MENSILE a mezzo bonifico permanente di \u20ac 25,00 a partire dalla data di sottoscrizione fino a revoca, quali quote associative\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3466-field_81_1\">Versamento MENSILE a mezzo bonifico permanente di \u20ac 25,00 a partire dalla data di sottoscrizione fino a revoca, quali quote associative<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3466-field_81_2\" name=\"wpforms[fields][81][]\" value=\"Versamento ANNUALE entro 31 marzo di ogni anno di \u20ac 300,00 fino a revoca, quali quote associative\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3466-field_81_2\">Versamento ANNUALE entro 31 marzo di ogni anno di \u20ac 300,00 fino a revoca, quali quote associative<\/label><\/li><\/ul><\/div><div id=\"wpforms-3466-field_83-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"83\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_83\">Scelta della Forma di Pagamento <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3466-field_83\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3466-field_83_1\" name=\"wpforms[fields][83][]\" value=\"Versamento MENSILE a mezzo bonifico permanente di \u20ac 10,00 a partire dalla data di sottoscrizione fino a revoca, quali quote associative\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3466-field_83_1\">Versamento MENSILE a mezzo bonifico permanente di \u20ac 10,00 a partire dalla data di sottoscrizione fino a revoca, quali quote associative<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3466-field_83_2\" name=\"wpforms[fields][83][]\" value=\"Versamento ANNUALE entro 31 marzo di ogni anno di \u20ac 120,00 fino a revoca, quali quote associative\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3466-field_83_2\">Versamento ANNUALE entro 31 marzo di ogni anno di \u20ac 120,00 fino a revoca, quali quote associative<\/label><\/li><\/ul><\/div><div id=\"wpforms-3466-field_42-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"42\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_42\">Autorizzo <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3466-field_42\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3466-field_42_1\" name=\"wpforms[fields][42][]\" value=\"L&#039;Amministrazione ad effettuare una trattenuta sulla mia retribuzione mensile in favore del Sindacato dei Medici Italiani, IBAN IT57A0200841160000400075597 - Unicredit Banca, secondo le seguenti modalit\u00e0:\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3466-field_42_1\">L'Amministrazione ad effettuare una trattenuta sulla mia retribuzione mensile in favore del Sindacato dei Medici Italiani, IBAN IT57A0200841160000400075597 - Unicredit Banca, secondo le seguenti modalit\u00e0:<\/label><\/li><\/ul><\/div><div id=\"wpforms-3466-field_89-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"89\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_89\">Autorizzo <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3466-field_89\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3466-field_89_1\" name=\"wpforms[fields][89][]\" value=\"L&#039;Amministrazione ad effettuare una trattenuta sulla mia retribuzione mensile in favore del Sindacato dei Medici Italiani, IBAN IT44B0200841160000021025899 - Unicredit Banca, intestato a FVM Medici Sezione SMI secondo le seguenti modalit\u00e0:\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3466-field_89_1\">L'Amministrazione ad effettuare una trattenuta sulla mia retribuzione mensile in favore del Sindacato dei Medici Italiani, IBAN IT44B0200841160000021025899 - Unicredit Banca, intestato a FVM Medici Sezione SMI secondo le seguenti modalit\u00e0:<\/label><\/li><\/ul><\/div><div id=\"wpforms-3466-field_43-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-hide\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_43\">Importo Trattenuta - Mensile <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3466-field_43\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3466-field_43_1\" name=\"wpforms[fields][43][]\" value=\"Euro 25,00\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3466-field_43_1\">Euro 25,00<\/label><\/li><\/ul><\/div><div id=\"wpforms-3466-field_97-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"97\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_97\">Importo Trattenuta - Annuale <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3466-field_97\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3466-field_97_1\" name=\"wpforms[fields][97][]\" value=\"Euro 55,00\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3466-field_97_1\">Euro 55,00<\/label><\/li><\/ul><\/div><div id=\"wpforms-3466-field_93-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"93\"><\/div><div id=\"wpforms-3466-field_94-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"94\"><\/div><div id=\"wpforms-3466-field_92-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"92\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_92\">Firma - Deposita qui la tua firma in formato elettronico usando il mouse o il touch screen del tuo dispositivo mobile. Usa la X in alto a destra per resettare e reinserire la firma<\/label><input type=\"text\" id=\"wpforms-3466-field_92\" class=\"wpforms-signature-input wpforms-screen-reader-element\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][92]\" autocomplete=\"off\" ><div class=\"wpforms-signature-wrap wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-3466-field_92-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Pulisci la firma\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" height=\"1em\" preserveAspectRatio=\"xMidYMid meet\" viewBox=\"0 0 1536 1536\">\n\t\t\t\t\t<path fill=\"var( --wpforms-field-text-color, rgba(0, 0, 0, 0.25) )\" d=\"M1149 994q0-26-19-45L949 768l181-181q19-19 19-45q0-27-19-46l-90-90q-19-19-46-19q-26 0-45 19L768 587L587 406q-19-19-45-19q-27 0-46 19l-90 90q-19 19-19 46q0 26 19 45l181 181l-181 181q-19 19-19 45q0 27 19 46l90 90q19 19 46 19q26 0 45-19l181-181l181 181q19 19 45 19q27 0 46-19l90-90q19-19 19-46zm387-226q0 209-103 385.5T1153.5 1433T768 1536t-385.5-103T103 1153.5T0 768t103-385.5T382.5 103T768 0t385.5 103T1433 382.5T1536 768z\"\/>\n\t\t\t\t<\/svg>\n\t\t\t\t<div class=\"wpforms-signature-clear-caption\">Pulisci la firma<\/div>\n\t\t\t<\/div><\/div><\/div><div id=\"wpforms-3466-field_100-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"100\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_100\">Annullamento \/ Non Annullamento Validit\u00e0 Delega<\/label><ul id=\"wpforms-3466-field_100\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3466-field_100_1\" name=\"wpforms[fields][100]\" value=\"Questa Delega ANNULLA Eventuali Altre Deleghe Precedenti\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3466-field_100_1\">Questa Delega ANNULLA Eventuali Altre Deleghe Precedenti<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3466-field_100_2\" name=\"wpforms[fields][100]\" value=\"Questa Delega NON ANNULLA Eventuali Altre Deleghe Precedenti\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3466-field_100_2\">Questa Delega NON ANNULLA Eventuali Altre Deleghe Precedenti<\/label><\/li><\/ul><\/div><div id=\"wpforms-3466-field_44-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"44\"><label class=\"wpforms-field-label\" for=\"wpforms-3466-field_44\">Autorizzo al Trattamento dei Dati Personali <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-3466-field_44\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3466-field_44_1\" name=\"wpforms[fields][44][]\" value=\"Dichiaro di prestare il consenso al trattamento dei miei dati personali ai sensi dell\u2019art. 13 del Regolamento UE n. 2016\/679 (GDPR) e art. 13 del D.lgs 196\/2003 e s.m.i.. \" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3466-field_44_1\">Dichiaro di prestare il consenso al trattamento dei miei dati personali ai sensi dell\u2019art. 13 del Regolamento UE n. 2016\/679 (GDPR) e art. 13 del D.lgs 196\/2003 e s.m.i..<\/label><\/li><\/ul><\/div><div id=\"wpforms-3466-field_62-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"62\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><\/div><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-3466-field-hp\" class=\"wpforms-field-label\">Name<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-3466-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"3466\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/sindacatomedicitaliani.it\/index.php\/wp-json\/wp\/v2\/pages\/4458\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-3466\" class=\"wpforms-submit\" data-alt-text=\"Invio in corso...\" data-submit-text=\"Invia\" aria-live=\"assertive\" value=\"wpforms-submit\">Invia<\/button><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Form di Iscrizione Sindacato dei Medici Italiani Fai clic qui se hai bisogno di supporto<\/p>\n","protected":false},"author":5,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-no-title","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/sindacatomedicitaliani.it\/index.php\/wp-json\/wp\/v2\/pages\/4458"}],"collection":[{"href":"https:\/\/sindacatomedicitaliani.it\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sindacatomedicitaliani.it\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sindacatomedicitaliani.it\/index.php\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/sindacatomedicitaliani.it\/index.php\/wp-json\/wp\/v2\/comments?post=4458"}],"version-history":[{"count":35,"href":"https:\/\/sindacatomedicitaliani.it\/index.php\/wp-json\/wp\/v2\/pages\/4458\/revisions"}],"predecessor-version":[{"id":10606,"href":"https:\/\/sindacatomedicitaliani.it\/index.php\/wp-json\/wp\/v2\/pages\/4458\/revisions\/10606"}],"wp:attachment":[{"href":"https:\/\/sindacatomedicitaliani.it\/index.php\/wp-json\/wp\/v2\/media?parent=4458"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}