[The recommendation of Marianne and Margaritha for the Nobel Peace Prize] One Million Signatures Campaign
Consent on Collection and Use of Personal Information
I have full knowledge of conditions mentioned below (based on Clause 2, Article 15, Personal Information Protection Act) and shall decide whether or not provide my personal informaton.

1. The purpose: to create the database of One Million Signatures Campaign
2. The particulars to be collected: Name, E-mail address, Country, City, Zip Code and Address
3. The Retaining Period: Until the end of One Million Signatures Campaign

Do you consent on collection and use of personal information? *
Name *
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E-mail address *
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Country *
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City *
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Signature *
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