The undersigned requests to participate to GINSANA PRIZE L`ARTE

The undersigned requests to participate to GINSANA PRIZE L’ARTE VESTE L’AZIENDA
(A COMPANY CLOTHED IN ART):
Name Surname ________________________________________________
Day of birth ____________________________________________________
Address ________________________________ Postcode______________
Town ________________________ Region/Canton _____ Country________
E-mail ________________________________________________________
Phone number / fax/ mobile ________________________________________
I have read and approved the announcement of the GINSANA PRIZE L’ARTE VESTE
L’AZIENDA (A COMPANY CLOTHED IN ART)
Place and date _____________________ Signature ______________________