IMOC Registration Form

First Name:

Surname:

Social Security:

Gender:

MF

Date of birth:

Place of birth:

Nationality:

Street:

Number:

City:

Postal Code:

Country:

Telephone:

Email:

My instrument or voice:

Ensemble name:

Conservatory or musical institute actually attended:

How did you hear about our courses? (Newspapers, Brochures, web, word of mouth ...)

I wanten roll to Festival IMOC 2020 by Centro Studi Musica & Arte

I agree to the membership fee of €50

Masterclass/Course given by prof

I wantenroll the master class/Course

Choose the type of participation

Standard studentan auditor of master classCarta Docente

Attachments

Curriculum:

Photocopy: front (first field) and back (second field) of the identity document or passport (in JPG or PDF)

Receipt:Copy of payment receipt (BIC BCITITMM -IBAN IT31E030 6909606100 000070202 - Intesa San Paolo Bank in name of Centro Studi Musica & Arte) the present enrollment will be invalid without the attached payment of the registration fee of € 50.

RepertoireIt is required to write down all the pieces you intend to play(max 2 with piano) or sing during lessons and at final concert (chamber music, duo with piano, concert with orchestra, repertoire for solo instrument).

Composer and Title

I enclose a copy of the parts for the pianistic staff (required).

EnsembleReserved for the candidates who intend to partecipate in the courses as an ensemble.

Name of ensemble

Type of ensemble

Names of the ensemble members

Accomodationi would like to lodge

my request has been sent to the Associazione Albergatori di Chianciano Terme that will contact me directly by e-mail

YES

Estimatedarrival date

Estimateddeparture date

I would like to inform the secretary office that

Authorizations and Signature

In accordance with art. 10 and 320 civ. code and art. 96 and 97 of law 22.4.1941, n. 633, Leggesuldirittod’autore, I give consent of publishing/sharing photos or videos on web, written paper and/or any other mean of communication.

YES

In accordance with D.Lgs. 196/03 I give consent to treatment by the Centro Studi Musica e Arte of personal data acquired by the Association for its work to institutional purpose related or to instrumental activities of the fondazione, as legally expected. I declare to be aware of the treatment of personal data set by the D.Lgs. 196/03.

YES

I declare to accept the Regulation Form IMOC 2020

YES

Place:

Date:

If Under AgeMather’s or father’s surname and first name

Name:

Surname:

Gender:

MF

Date of birth:

Place of birth:

Nationality:

Street:

Number:

City:

Postal Code:

Country

Phone:

Email:

Social Security Number:

In accordance with art. 10 and 320 civ. code and art. 96 and 97 of law 22.4.1941, n. 633, Legge sul diritto d’autore, I give consent of publishing/sharing photos or videos on web, written paper and/or any other mean of communication.

YES

In accordance with D.Lgs. 196/03 and art 13 UE REG. n. 2016/679, I give consent to treatment by the Centro StudiMusica e Arte of personal data acquired by the Association for its work to institutional purpose related or to instrumental activities of the fondazione, as legally expected. I declare to be aware of the treatment of personal data set by the D.Lgs. 196/03 and art. 13 UE REG. n. 2016/679.

YES

I declare to accept the Regulation Form IMOC 2020

YES

Place:

Date: