Registration form
ATTENTION

You must correctly complete the red fields.

My personal data are as follows:

  • surname
    		•
  • name
    		•
  • place of birth
    		•
  • date of birth
    		•  (dd-mm-yyyy)
  • type of ID document
    		•
  • number of an ID document
    		•
  • istitution that has emitted the document
    		•
  • address
    		•
  • city
    		•
  • state/province
    		•
  • country
    		•
  • phone
    		•
  • mobile
    		•
  • amount of the contribution (see table)
    		•
  • e-mail address (needed to complete registration)
    		•
  • activity
    		•

    Proceeding with the registration I declare to have read Pravartya rules published on Pravartya website.

    I choose my personal username and password to log-in to Pravartya account (please note for not forget them).

  • username
    		•

  • password
    		•
  • type again password
    		•
    Note: Password must be correctly entered. Insert at least 6 alphanumeric characters. Type in at least 1 capital character and at least 2 numbers.
    Example password: exe14Mple