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Form di Prova x inserimento nel database

 

Last Name

 Name Age
 City Region State
Business or Profession   
 
Business / Company   Home
Company Name
Address
Phone
Fax
E-mail
Address
Phone
Fax
E-mail
 
Nature/ scope of your Business or Profession 
If your Business/profession can benefit with contact abroad,  ( to buy from or to sellto those countries), state the country you are interested in and the nature of assistance you are seeking
If a member of 41 Club from abroad is seeking help for the benefit of his business/profession in your country ( to buy or to sell to India) would you be able to help? If so , briefly state what could be the nature of help you can offer....

Detail your preference in the following leisure activities 

Travel/ Holidays
 
Hobbies 
 
Other Passion
Any Suggestions for the benefit of the program ?