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Registration Form
[Guest Book]


(Italian Form: click here)


Obligatory data
(Visible data)


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


Optional data
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Are you a Gold Prospector? NO YES

  If you have selected YES, what type of accessories do you use?
  


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



Invisible data
(The answers to this section won't be public)


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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