NAME                                                        

SURNAME                                                 

E-MAIL                                                         

RE-HIT E-MAIL TO CONFIRM                

AGE                                                             

SEX                                                            M                        F                                                                               

COUNTRY                                                 

CITY                                                               

DO YOU FLY FOR OTHER VAs?             YES NO

IF YES IN WHICH?                                   

IF YOU HAVE OTHER TO SAY...