Registration form

To “Circolo della Zampogna”

Piazza Martiri di Scapoli

86070 – Scapoli (IS) – Italy

Name and Surname

______________________________________________________________

______________________________________________________________

Place and date of birth

______________________________________________________________

______________________________________________________________

Full address (including postal code)

______________________________________________________________

______________________________________________________________

Tel.  ________________________________

e-mail  _____________________________________________

Date _____________________

Signature _________________________