10m² Competition

Welcome to 10m²

Fill out the form, you will immediately receive an email with your personal Code and a Media Pack. Please note: all the members of the group must be registered; the number of members is final and can not be changed later.
category*

studentprofessional
number of members*

12345
member n°1

please note: if groups, member n°1 is the leader one.
name + surname*

NomeCognome
where are you from?*

Indirizzo

Indirizzo Riga 2

CityNazione / Provincia

Codice PostaleCountry
date of birth*

GiornoMeseAnno
discipline*
e-mail*
phone number*
I agree to the processing of my personal data*

I agree
member n°2
name + surname*

NameSurname
where are you from?*

Indirizzo

Indirizzo Riga 2

CityNazione / Provincia

Codice PostaleCountry
date of birth*

GiornoMeseAnno
discipline*
e-mail*
phone number*
I agree to the processing of my personal data*

I agree
member n°3
name + surname*

NameSurname
where are you from?*

Indirizzo

Indirizzo Riga 2

CityNazione / Provincia

Codice PostaleCountry
date of birth*

GiornoMeseAnno
discipline*
e-mail*
phone number*
I agree to the processing of my personal data*

I agree
member n°4
name + surname*

NameSurname
where are you from?*

Indirizzo

Indirizzo Riga 2

CityNazione / Provincia

Codice PostaleCountry
date of birth*

GiornoMeseAnno
discipline*
e-mail*
phone number*
I agree to the processing of my personal data*

I agree
member n°5
Name + Surname*

NameSurname
where are you from?*

Indirizzo

Indirizzo Riga 2

CityNazione / Provincia

Codice PostaleCountry
country*
date of birth*

GiornoMeseAnno
discipline*
e-mail*
phone number*
I agree to the processing of my personal data*

I agree
i want to receive news or updates from Periferica Media Partners

I want
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Welcome to 10m²

member n°1

member n°2

member n°3

member n°4

member n°5