REGISTRATION FORM REGISTRATION FORM by ColleenEynon

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									                                                                          REGISTRATION FORM                                                                                                                                                 REGISTRATION FORM




                                                                                                                                        Q4.20.10.90051.SR.01.01




                                                                                                                                                                                                                                                                                                          Q4.20.10.90051.SR.01.01
                                              Order code: 90051                                                                                                                                                 Order code: 90051


                                                                            Date / Datum:                                                                                                                                                     Date / Datum:


                                                                           Submission type (enter ‘X’) / Vrsta prijave (upišite ‘X’):                                                                                                        Submission type (enter ‘X’) / Vrsta prijave (upišite ‘X’):

                                                                               New registration / Nova registracija                                                                                                                              New registration / Nova registracija
                                                                               Data change/update / Izmena/dopuna podataka                                                                                                                       Data change/update / Izmena/dopuna podataka
     www.q4you.biz                                                                                                                                                     www.q4you.biz
Form should be completed clearly, with capital letters! / Formular popunite čitko, štampanim slovima!                                                             Form should be completed clearly, with capital letters! / Formular popunite čitko, štampanim slovima!
 PERSONAL DATA / LIČNI PODACI                                                                                                                                      PERSONAL DATA / LIČNI PODACI
Registration ID (Nickname) / Registracioni kod (Nadimak):                                                                                                         Registration ID (Nickname) / Registracioni kod (Nadimak):

First name / Ime:                                  Last name / Prezime:                                   Gender / Pol:                                           First name / Ime:                                  Last name / Prezime:                                   Gender / Pol:

Personal ID / Matični broj (JMBG):                                                    Date of birth / Datum rođenja:                                              Personal ID / Matični broj (JMBG):                                                    Date of birth / Datum rođenja:


 CONTACT INFORMATION / KONTAKT INFORMACIJE                                                                                                                         CONTACT INFORMATION / KONTAKT INFORMACIJE
Contact/mail delivery address / Adresa za kontakt i prijem pošte:                                                                                                 Contact/mail delivery address / Adresa za kontakt i prijem pošte:

ZIP code / Poštanski broj:        City / Mesto:                                       Country / Država:                                                           ZIP code / Poštanski broj:        City / Mesto:                                       Country / Država:

Q4 mobile phone / Q4 mobilni telefon:                                                                                                                             Q4 mobile phone / Q4 mobilni telefon:

Other mobile phone / Drugi mobilni telefon:                         Home phone / Kućni telefon:                                                                   Other mobile phone / Drugi mobilni telefon:                         Home phone / Kućni telefon:

E-mail:                                                                                                                                                           E-mail:


 OTHER (optional) / OSTALO (popuniti po želji)                                                                                                                     OTHER (optional) / OSTALO (popuniti po želji)
Education level / Stepen obrazovanja:                               Occupation / Zanimanje:                                                                       Education level / Stepen obrazovanja:                               Occupation / Zanimanje:

City of employment / Mesto zaposlenja:             Company name / Naziv firme:                                                                                    City of employment / Mesto zaposlenja:             Company name / Naziv firme:

Preferred language for reports/information reception / Poželjan jezik za prijem izveštaja/informacija:                                                            Preferred language for reports/information reception / Poželjan jezik za prijem izveštaja/informacija:

Important event in Your life - date and description / Važan događaj u Vašem životu - datum i opis:                                                                Important event in Your life - date and description / Važan događaj u Vašem životu - datum i opis:


 SPONSOR (MENTOR) DATA / PODACI O SPONZORU (MENTORU)                                                                                                               SPONSOR (MENTOR) DATA / PODACI O SPONZORU (MENTORU)
Registration ID (Nickname) / Registracioni kod (Nadimak):                                                                                                         Registration ID (Nickname) / Registracioni kod (Nadimak):

First name / Ime:                                                   Last name / Prezime:                                                                          First name / Ime:                                                   Last name / Prezime:


I hereby state that I am fully aware and accept the rules of Book of Regulations and of General Terms of Product and Service                                      I hereby state that I am fully aware and accept the rules of Book of Regulations and of General Terms of Product and Service
Purchase and Delivery. I agree to receive various promotional and informational contents in electronic and printed form,                                          Purchase and Delivery. I agree to receive various promotional and informational contents in electronic and printed form,
delivered periodically by Q4you or its affiliates on contacts and addresses stated above. / Izjavljujem da sam u potpunosti                                       delivered periodically by Q4you or its affiliates on contacts and addresses stated above. / Izjavljujem da sam u potpunosti
upoznat/a i da prihvatam odredbe Pravilnika o poslovanju i odredbe Opštih uslova za prodaju i isporuku robe i usluga. Dajem                                       upoznat/a i da prihvatam odredbe Pravilnika o poslovanju i odredbe Opštih uslova za prodaju i isporuku robe i usluga. Dajem
saglasnost da na navedene kontakte i adrese periodično dobijam različite promotivne i informativne sadržaje kompanije Q4you ili                                   saglasnost da na navedene kontakte i adrese periodično dobijam različite promotivne i informativne sadržaje kompanije Q4you ili
njenih partnera, u elektronskoj i štampanoj formi.                                                                                                                njenih partnera, u elektronskoj i štampanoj formi.
NOTE: It is in Your best interest to enter the correct data in the form, and to submit all the changes/updates regularly. We                                      NOTE: It is in Your best interest to enter the correct data in the form, and to submit all the changes/updates regularly. We
do not accept any possible damage or responsibility caused by incorrect or incomplete data submission. / NAPOMENA: U                                              do not accept any possible damage or responsibility caused by incorrect or incomplete data submission. / NAPOMENA: U
Vašem je interesu da podaci koje unosite u formular budu tačni i da redovno prijavljujete sve izmene i dopune. Eventualne štete i                                 Vašem je interesu da podaci koje unosite u formular budu tačni i da redovno prijavljujete sve izmene i dopune. Eventualne štete i
odgovornost zbog netačnih ili nepotpunih podataka - ne priznajemo.                                                                                                odgovornost zbog netačnih ili nepotpunih podataka - ne priznajemo.


                                                                                                    Signature / Potpis                                                                                                                                                Signature / Potpis

								
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