Request to supply details of held personal data

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First Name *

Last Name *

Street Address *

Street Address Line 2

City *

State/Province/Region *

Postal / Zip Code *

Country *

Phone

(include country, area code, phone number)

I would like the IAP to send me all the details of the personal data that is held for me in their records.

I understand that this can only be sent to the address or email that is already held in the IAP records and that the IAP will contact me to confirm my identity before releasing any of these details.

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This form was created inside of International Academy of Pathology.