Register for membership

Submitted by admin on Mon, 02/20/2017 - 22:09

Title *

Name *

Surname *

Personal address *

ZIP/CAP *

City *

Citizenship *

Country *

Codice fiscale (only for Italian citizens: if you are a foreigner please type '0') *

Date of birth *

Month

Day

Year

Affiliation

Telephone number

Email address *

Alternative email address

Payment *

Please define how you want to proceed for the payment

Paypal/CreditCard

Bank Transfer

I hereby authorize the treatment of my personal data according to the privacy law D.Lgs. 196/2003 *

Yes

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