Compile the form then click Submit. If you want to keep anonymous, you can avoid the fields that are not mandatory. The fields indicated by a * must be filled. If needed you will be contacted at the e-mail address you wrote, so be careful writing it. Any data about your person will be used only by the author and won't be given to anyone else without explicit authorization of the submitter.
Note: you can be sure that any personal data you submit (name, e-mail address and geographic area) won't be told to anyone without your explicit authorization. For the same reason your e-mail address won't be used for malicious actions like spamming or mailing lists subscription. The only exception is for your IP address that will be told to the user that will receive the confirming e-mail to be sure that you are not using this service with spamming intentions.