to the workshop of : *





name and surname *


address *


date of born


CAP e provincia


e-mail: *


tel. fix e/o cell:


To confirm registration, send deposit of 60 € on the bank transfer to: Account owner: La Terra Galleggiante - via Chiappero n ° 12 - 10064 Pinerolo. bank: BANCA PROSSIMA - IT72E0335901600100000005851 (BIC): BCITITMX with reason: Registration seminar: …………………. entries that are not accompanied by account will be held in abeyance.


copy of the receipt of payment (optional)


report any different sender of the bank transfer: