domanda d’iscrizione / application form - concorsopozzoli.it · programma per le prove /...
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DOMANDA D’ISCRIZIONE / APPLICATION FORM
Avvertenze: Compilare la domanda e via email a [email protected] Note: Please fill in the application form and send it by email at [email protected]
CONCORRENTE / COMPETITOR
Cognome / Surname ____________________________________________________________________
Nome / First Name _____________________________________________________________________
Sesso / Gender M F Nazionalità / Nationality ____ ___Data di nascita / Date of Birth ______________
Luogo di nascita / Place of Birth __________________Nazione/Country___________________ _________
Residenza / State of residence
Stato / State ___________________________________________________________________________
Via / Street _____________________________________ Città / City ______________________________
Telefono / Telephon_______________________________Fax____________________________________
cell. / mobile______________________________________e-mail__________________________________
Domicilio / Domicile (se diverso dalla residenza / if different from the place of residence) dal 29.10 al 25.11
Stato / State ___________________________________________________________________________
Via / Street _____________________________________ Città / City ______________________________
Telefono / Telephone ____________________________________________________________________
e-mail ________________________________________________________________________________
GENITORE O TUTORE / PARENT OR GUARDIAN
Nome e Cognome / Name and Surname _________________________________________
Data di nascita / Date of Birth ______________ Luogo di nascita / Place of Birth _____________________
Codice fiscale / Fiscal code _______________________________________________________________
(only for italian)
Residenza / State of residence
Stato / State ___________________________________________________________________________
Via / Street _____________________________________ Città / City ______________________________
Telefono / Telephon_______________________________Fax____________________________________
Cell. / mobile______________________________________e-mail__________________________________
Domicilio / Domicile (se diverso dalla residenza /if different from the place of residence) dal 29.10- 25.11.18
Stato / State ___________________________________________________________________________
Via / Street _____________________________________ Città / City ______________________________
Telefono / Telephone ____________________________________________________________________
e-mail ________________________________________________________________________________
Accetto le condizioni del regolamento ed allego i documenti richiesti e la tassa di iscrizione. I agree to abide by the regulations of the competition and I enclose the document and the enrolment fee. Data / Date ________________________ Firma Concorrente / Signature Competitor _______________
Data / Date ________________________ Firma Tutore / Signature Tutor _________________________
I dati sono raccolti e conservati secondo la normativa italiana a tutela della privacy. Il documento informativo della normativa sulla tutela della privacy si può trovare sul sito del Concorso. Data are collected and stored according to the Italian privacy law. The information memorandum on the protection privacy law can be found on the website of the Competition. Firma Concorrente / Signature Competitor _______________
Firma Tutore / Signature Tutor _________________________
CURRICULUM VITAE
Cognome / Surname ____________________________________________________________________
Nome / First Name _____________________________________________________________________
Elenco degli studi conseguiti / List your diplomas _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Elenco degli insegnanti / List your teachers
Nome e Cognome / Name and Surname (stampatello / Block letters) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Elenco dei principali premi vinti / List your important prizes _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Firma / Signature _____________________________________
PROGRAMMA PER LE PROVE / REPERTOIRE Categoria A / Category A
I brano obbligatorio / First Compulsory study
E. Pozzoli da/from “24 piccoli studi facili e progressivi”: n._______________________________________ II brano obbligatorio / Second Compulsory piece E. Pozzoli dalle Piccole scintille: n. _________________________________________________________ Programma a libera scelta / Free programme _____________________________________________________________________________________ _____________________________________________________________________________________ _______________________________________________________________________________________
PROGRAMMA PER LE PROVE / REPERTOIRE Categoria B / Category B
I brano obbligatorio / First Compulsory study
E. Pozzoli dai 15 studi facili per le piccole mani: n._______________________________________ II brano obbligatorio / Second Compulsory piece E. Pozzoli dalla suite di Pinocchio: n. _______________________________________________________ Programma a libera scelta / Free programme _____________________________________________________________________________________ _____________________________________________________________________________________ _______________________________________________________________________________________
PROGRAMMA PER LE PROVE / REPERTOIRE Categoria C / Category C
I brano obbligatorio / First Compulsory study
E. Pozzoli dagli studi a moto rapido: n._______________________________________ II brano obbligatorio / Second Compulsory piece E. Pozzoli dalle impressioni fascicolo II: n. ___________________________________________________ Programma a libera scelta / Free programme _____________________________________________________________________________________ _____________________________________________________________________________________ _______________________________________________________________________________________
PROGRAMMA PER LE PROVE / REPERTOIRE Categoria D / Category D
I brano obbligatorio / First Compulsory study
E. Pozzoli dagli studi di media difficoltà: n._______________________________________ II brano obbligatorio / Second Compulsory piece E. Pozzoli dai Riflessi del mare: n. _________________________________________________________ Programma a libera scelta / Free programme _____________________________________________________________________________________ _____________________________________________________________________________________ _______________________________________________________________________________________
III brano obbligatorio / Third Compulsory piece _______________________________________________________________________________________
PRENOTAZIONE ALLOGGIO / BOOKING ACCOMODATION
Richiedete l’alloggio ? / Do you require accomodation? sì / yes no
Hotel (prenotazione e spese a carico del concorrente) (booking and expenses paid by the competitors) Famiglia (ai primi 30 iscritti e relativi accompagnatori indipendentemente dalla categoria) / Family
(to the first 30 applicants and their supervisors, regardless of their categories) (gratis / free) Solo per chi sceglie la famiglia: / Only for those who choose a family: (Queste informazioni serviranno per la famiglia che vi ospiterà / These information will be used by your host family) A partire da / from ______________________________________________________________________ (1 giorno prima per i concorrenti che arrivano dalla UE e 2 giorni prima per concorrenti che arrivano da paesi extra UE) / (1 day before the competition for EU contestants and 2 days before for non-EU) Lingue parlate / spoken languages _________________________________________________________ Allergie / Allergies ______________________________________________________________________ Fumatore? / Are you a smoker? ____________________________________________________________ Richieste o preferenze particolari / Special requests or preferences ________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Altro / Anything else _____________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Data / Date ________________________ Firma / Signature ____________________________________