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 2019 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 paymentreceipt(IBAN IT 75 I 03359 01600 10000 00702 02 - BIC BCITITMX – Banca prossima in name of Centro Studi Musica & Arte) the presentenrollmentwill be invalidwithout the attachedpayment of the registrationfee 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

myrequesthasbeensent to the Associazione Albergatori di Chianciano Terme thatwillcontact 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 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.

YES

I declare to accept the Regulation Form IMOC 2019

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, 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 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 2019

YES

Place:

Date: