Stay Request Form | Biobanco of the Public Health System of Andalusia

Stay Request Form for the Biobank of the Public Health System of Andalusia

Personal Information

Last Name:

Name:

Postal Address:

Postal Code:

Province/Estate:

Location:

Country:

Tax Identification Number:

Passport/NIE (for foreigners only):

Nationality:

Phone number:

e-mail:

Professional Information

Academic Qualifications (Indicating, if applicable, area of knowledge):

Institution or Company where you work:

Place and Job Position:

Postal code:

Phone number:

Professional Postal Address:

Location:

Stay Information

The Biobank of the Public Health System of Andalusia offers the following units for the stay:

Service Management and Circuit Coordination Unit
Donor Registration Unit
Biobank Information Systems Unit
Histological Quality Control Unit
Cell Lines Unit
Genetic and Biomarker Quality Control Unit
Sample Stabilization and Biorepository Unit

Each of these will be available according to the selected Node.

Node where the stay will take place:

Units available in the selected Node for the stay:

Expected Duration (months):

Start Date:

Finishing Date:

Specific objectives you wish to achieve during the duration of your stay:

Information on Data Protection

In compliance with Articles 13 and 14 of the General Data Protection Regulation and Organic Law 3/2018, of December 5, on the Protection of Personal Data and Guarantee of Digital Rights, we inform you of the following:

The personal data you provide will be used for contact processing purposes in order to address the requests for consultation submitted, as well as to inform you of the services offered by the Foundation. The data will be stored for as long as necessary to comply with the legal obligations stipulated. Your data will not be transferred to third parties, unless required by law. The legal basis for this processing is the consent you provide by completing and submitting the form or email, without which we would not be able to fulfill the described purpose.
The data controller for your personal data is the Fundación Pública Andaluza Progreso y Salud, located at Av. Américo Vespucio Nº15, building S-2, 41092 Seville.
You can contact the Data Protection Officer at the following email address: dpd.csalud@juntadeandalucia.es
You may exercise your rights of access, rectification, erasure, portability, and restriction or objection to the processing of your data by submitting a written request with a copy of your ID to the Fundación Pública Andaluza Progreso y Salud, at Av. Américo Vespucio Nº15, building S-2, 41092 Seville, or by email to lopd.fps@juntadeandalucia.es

I have read and accept the General Data Protection Regulation