How did you hear about the Prize? Signature. Virtual Art. Digital Graphic. Painting. Video Art. Performance. Sculpture and Installation. Photographic Art. Land Art.
APPLICATION FORM TO ATTACH TO THE DOSSIER SEND IN A SEALED ENVELOPE WITHIN NOVEMBER 16TH 2017 TO: (date as postmark) Premio Arte Laguna Via Roma, 29/A - 31021 Mogliano V.to (TV)
APPLICATION FORM TO PARTICIPATE IN THE 12TH INTERNATIONAL ART PRIZE ARTE LAGUNA Painting Virtual Art
Sculpture and Installation Digital Graphic
Photographic Art Land Art
Video Art
Urban Art
Name
Attach:
Surname
1. Biography 2. Photo of each artwork / Dvd (max 2 Gb) 3. Payment of the application fee of:
Place and Date of birth Address Phone/Mobile
Performance
e55 (1 artwork)
e105 (2 artworks)
e155 (3 artworks)
e205 (4 artworks)
for artist Under 25:
E-Mail
e50 (1 artwork)
e95 (2 artworks)
Web site
e140 (3 artworks)
e185 (4 artworks)
Artwork 1* Title and Year
payed on (date) to Associazione Culturale MoCA with the reason of “Prize 17.18” through:
Artwork 2*
Bank Transfer Banca Popolare dell'Emilia Romagna - BIC: BPMOIT22XXX IBAN: IT 68 N 05387 61800 000002469464 Credit Card on artelagunaprize.com
Title and Year
MoneyGram to Laura Gallon - Mogliano V.To (TV) Italy How did you hear about the Prize?
Artwork 3* Title and Year
Artwork 4* Title and Year
I accept: 1. All rules of the regulation published on www.artelagunaprize.com 2. To give the Cultural Association MoCA the right of replication of the works and texts for the realization of the Catalogue, the Archive of entries, the Publication of the artworks in the website of the prize and other forms of communication and activities of the organization. 3. To give the Cultural Association MoCA the authorization to the treatment of the personal data according to the law on the privacy (Legislative Decree n°675/96 and n°196/2003).
*Write Size, Technique and Material on the back of the photography of the artwork or into the Dvd
How did you hear about the Prize? Signature. Virtual Art. Digital Graphic. Painting. Video Art. Performance. Sculpture and Installation. Photographic Art. Land Art.
Email: Website: List items to be sold and describe (include photos of ALL items). 1. ... If you are unable to provide your own tables/chairs, you may rent one table.
TOTAL. Please send completed application and check payable to: ... Exhibitor's Signature. Date ... Digital picture copies are acceptable as long as they are high.
Harper's BAZAAR Singapore - SPHM Pte Ltd ... Postcode. Telephone. E-mail. How did you find out about BAZAAR. Art Prize: Website (If Any): ... Should there be any further enquiries about the competition, please email the marketing team at.
Computer related, if any). Name of Board / Institute. Duration of. Course. (in years). Month and Year. % of Marks. Obtained. Joining the course. Passing.
Journalist. Parliamentarian. Government. Academic. Other. Please specify, ... Please answer the following questions as completely and accurately as possible.
Advt.No. : 2. Post applied for : 3. Name (IN CAPITAL LETTERS) : 4. Father's/Husband's Name : 5. Date of Birth : (dd/mm/yy). ______ Month ______ Year. 6.
Company Name in Chinese (if any): ... Website: Country code City/Area code. Number. 2. Company Details (please tick all that ... 04 Design & styling service.
FOR APPRENTICESHIP TRAINING IN HAL, BANGALORE ... Mobile: I hereby declare that the above information is true to the best of my knowledge. Place: Date:.
PLEASE NOTE: Make sure to save a copy of this PDF to your computer before you fill it out. If you fill it out online any data you enter will be lost when you close.
Personal Information (please complete all fields). Family / Last Name: First / Given Name (s):. Gender: Female Male. Date of. Birth: Nationality: (DD/MM/YYYY).
