BACIO 19 Old Sport Hill Rd. Easton, CT 06612
Family Name *
Father's name and date of birth*
Mother's name and date of birth*
Street
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What kind of work did/do you do?
Suggestions of type of programs you would urge BACIO to conduct
Province or town in Italy from which you or your parents/grandparents originate
Check Date and Check Number
Children living in your home and date of birth*