Non Gamstop Casinos
Non Gamstop Casinos
Nombre /
Name
*
Apellidos /
Surname
*
Edad /
Age
*
Correo Electr�nico /
E-mail
*
Sitio Web /
Website
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Rut
(sin puntos ni gui�n)
/
Passport Number
*
Tel�fono /
Phone Number
*
Actividad o Profesi�n /
Job or Degree
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Comentario /
Comments
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* = informaci�n requerida /
required information
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He le�do y acepto el
Reglamento de Inscripci�n
I have read and agree to the
Inscription Rules
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