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Registration Form
[International Prospectors]


(Italian Form: click here)


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First Name: Last Name:
E-mail: City, State/Province, Country:


What type of accessories do you use?


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Comments (personal and/or on the web site):


If you have written any comments, would you like to see them in the "Guest Book" page? YES NO


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Date of birth: Sex: M F
Mail address: ZIP:
Telephone: Fax:
Occupation: Hobbies:
If you have a personal Home Page on Internet, indicate the address: Notes about Home Page:
How do you have known this site? If you have chosen "#" then specific which, if "Elsewhere" specific how:
Are you associated with any organizations of Gold Prospecting? YES NO If you have selected "YES" then indicate which:
Do you read magazines of Gold Prospecting regularly? YES NO
If you have selected "YES" then indicate which:
Would you like to receive possible catalogs and/or informations from Manufacturers/Retailers of Gold Prospecting? YES NO If you have selected "YES" then specific how (both also):       Mail
      E-mail



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