Creativity Award City of Marsciano

Name: ________________________________ Family name: _________________________________

Address:
Street name: ______________________________________________________ House number ___
City: _____________________________ Postcode: _____________________
Province: _______ Country: _________________________________
Date of birth: ____/____/_______ Place of birth : _________________________________
E mail (please, write your email account in a clear and readable way)
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Telephone(s) __________________________

__________________________

I will enter at the concourse for the following category: (painting, sculpture, installations, video art,
photography):
________________________
I gained knowledge of the concourse by:

Facebook Informagiovani (Italian youth centers) Paper publicity in places, clubs Mail
Website: _____________________________________________

Press

Others:
________________________________________________________________________
Title of the presented artwork: _______________________________________________________
Sizes (for Photography category, please indicate the format in which, if selected, you want to print the
photo) ________________________________________________
Technique: ___________________________________________________

I declare to accept what is set by the Announcement of the Concourse Creativity Award City of
Marsciano and I guarantee the authenticity of the information given with the present application form.
I grant the authorization to the handling of my personal data in relation to the event where I participate on the
base of the dispositions of the decree law N. 196 on 30/06/2003.

I declare that I didnt present my candidate artwork in previous editions of the concourse, and furthermore I declare that I never won a prize in other concourses with the same artwork.
Date and signature of the contestant

If minor: date and signature of the parent