Scheda di Iscrizione
(Application Form - Demande d'inscription - Einschreibungsautrag)

CONCORSO INTERNAZIONALE DI
INTERPRETAZIONE FLAUTISTICA

Sezione ____________________Categoria________________________________


Cognome e Nome______________________________________________________________
(Surname and First Name)
Data e Luogo di Nascita ________________________________________________________
(Date and Place of birth)
Via _________________________________________________________________________
(Street-Rue-Strasse)
CAP - Cittą - Paese_____________________________________________________________
(ZIP-Town-Country)
Telefono/E-Mail (Phone/E-Mail)___________________________________________________

Cognome e Nome______________________________________________________________
(Surname and First Name)
Data e Luogo di Nascita ________________________________________________________
(Date and Place of birth)
Via ________________________________________________________________________
(Street-Rue-Strasse)
CAP - Cittą - Paese_____________________________________________________________
(ZIP-Town-Country)
Telefono/E-Mail (Phone/E-Mail)___________________________________________________

Insegnante (Teacher):

Cognome e Nome______________________________________________________________
(Surname and First Name)
Via ________________________________________________________________________
(Street-Rue-Strasse)
CAP - Cittą - Paese_____________________________________________________________
(ZIP-Town-Country)
Telefono/E-Mail (Phone/E-Mail)___________________________________________________

---------
Programma (Program):_______________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Allegati(I enclose):
a) Fotocopia documento di identitą o autocertificazione (A personal identity certificate)
b) Assegno circolare non trasferibile o Vaglia Postale (Cheque)
Euro _________________________ quale quota di iscrizione.

Accetto incondizionatamente le norme del Bando di Concorso.
I accept inconditionally the regulations of the competition.

Firma (Signature)______________________________________________________

Firma Insegnante (Teacher Signature)_____________________________________

In caso di Duo compilare entrambi gli spazi.
In case of Duet fill up entirely the form.