The undersigned
(First Name and Last Name)*

Place of birth*

Date of birth*

Tax Code*

Resident in*

Street/Square*

Postal Code*

Telephone*

E-mail*

As an individual participant

As the team representative composed of:

Indicate: First Name, Last Name, Date of Birth, Tax Code, Address of residence, Telephone and Email of all team members.

A4 sheet (.pdf) Max 4Mb named "LastName_FirstName_WorkTitle"*

Curriculum Vitae (.pdf) Max 1Mb named "LastName_FirstName_CV"*

REQUESTS to participate in the SERGIO STAINO NATIONAL AWARD – Comic Section (cartoon, vignette, strip or illustration)

The undersigned, aware that, pursuant to Article 76 of Presidential Decree no. 445 of 28 December 2000, false statements, falsification of documents and use of false documents are punishable under the Penal Code and special laws,
DECLARES
- not to have any criminal convictions and not to be subject to preventive measures, civil decisions, or administrative provisions recorded in the criminal register;
- not to be subject to criminal proceedings;

AUTHORIZES
- the Centro Culturale Teatro Camuno of Breno to use personal data and the data contained in the attachments to the application for the purpose of managing all organizational, awarding, and promotional phases of the Award.

Also requests that any communication regarding this notice be sent to:

First Name and Last Name*

Telephone*

E-mail*

Any notes for the Award secretariat

AI consent to the processing of personal data and confirm that I have read the Privacy Policy

Acceptance