FICHA DE INSCRIPCIÓN                  REGISTRATION FORM
Sign in to Google to save your progress. Learn more
Email *
Nombres / Name *
Apellidos / Last Name *
Nacionalidad / Nationality *
Documento / Identification Document *
N° de Documento / Document N°
Sexo / Gender *
Dirección / Address *
Provincia / Distrito / District *
País / Country *
Celular / Cell phone number *
Email *
Empresa / Company Name *
Cargo / Position *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Instituto de Ingenieros de Minas del Perú.

Does this form look suspicious? Report