Last name and Name:
Address:
C.A.P.:
City, Province:
Telephone and fax:
E-mail:
Demands 
of information:
Authorize   No authorize
I authorize to you, to the senses of Legge art.13 e 23 del D. Lgs. 30 june 2003, n. 196, to the treatment of my personal data to the aims of one eventual activity of selection