ASSUMPTION OF RESPONSABILITY MODULE
for delegates

The undersigned_________________________________________________________

resident in _________________________________________    (    ________  )

address_____________________________________________________________

telephone _______________________________

having read and accepted in all the part the norms for the use of the computing center resources, asks the access to these resources as user of the computer:

Pisa,
 
 
 
 

                                                                                                                                        ( signature)

Authorization

Signature of the responsible of the computer:
 
 
 
 

                                                                                                                                   ( the responsible )

by the responsible

Account:  $\Box$ created  $\Box$ renewed      :         /         /
 

Expiration date:  $\Box$ 1 year  $\Box$ 6 months  $\Box$ 3 months  $\Box$ other:
 

Notes:
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