Application form:please use BLOCK CAPITALS 3rd Competition “Citta’ di Palmanova” including the “Filippo Trevisan” Piano Competition the “Lucia Ferigutti” Choir Competition Deadline for application 24th april 2015 SURNAME ________________________________ NAME ______________________________________ DATE OF BIRTH _______________ PLACE OF BIRTH _________________________________________ COUNTRY __________________________ CITIZENSHIP ___________________________________ ADDRESS_________________________ TOWN________________________ ZIP CODE _____________ TELEPHON ________________________ MOBILE ___________________________ E-MAIL ______________________________________________ SECTION __________ CATEGORIE __________________ SURNAME AND NAME OF THE TEACHER _____________________________ REPERTOIRE AUTHOR _________________ TITLE _______________ DURATION _______ AUTHOR _________________ TITLE _______________ DURATION _______ AUTHOR _________________ TITLE _______________ DURATION _______ TOTAL DURATION _______________ The completed application form and all documents required under point 11 of the Announcement must be sent by e-mail only to: [email protected] I hereby certify that I accept the Rules of the Competition and that the decisions of the Jury will be final and irrevocable. Date _______________ SIGNATURE (if under 18, signature of a parent is required) ____________________________
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