This appears to be a form with blanks for a name, organization, job title, phone number, and email address. It includes the year 2021 but is otherwise unclear as it contains mostly unintelligible characters.

1. F h d Is r ã
i a e n ci o
c ç
c ra a
an v l
21
01
N me___________________
o : __________________
_
______________________
______________________
Irj: __________________
gea_ __________________
_
______________________
______________________
T lfn : _________________
eeo e_ ________________
_
E i ___________________
: l __________________
Ma :
_