http://www.premioartelaguna.it
 

Application to Special Prize "Pas de Rouge"
Deadline Extended to January 10th, 2017

* mandatory fields
INFORMATION

NAME *
SURNAME *
DATE OF BIRTH *
(day-month-year)
PLACE OF BIRTH *
   
ADDRESS
COUNTRY *
CITY *
POSTECODE *
STREET *
PHONE *
MOBILE PHONE
-
E-MAIL *
REPEAT E-MAIL *
WEB SITE
CREATIVE PROPOSAL  
Short description *
Max 2MB - .DOC or .PDF file
maximum 2 pages in English language
   
Image *
Max 2MB - Jpg Format
   
Image
Max 2MB - Jpg Format
   
Image
Max 2MB - Jpg Format
   
 If you already enrolled to Arte Laguna Prize and paid the application fee, please, specify the method you used.
   
APPLICATION FEE * I payed the enrollment fee of €
date (day-month-year)
 
PAYMENT *

Postal Form
Bank Transfer
On-line by credit card
Western Union

   
SPECIFY THE NAME OF THE OWNER OF THE ACCOUNT OR WESTERN UNION CODE OR MONEYGRAM CODE
   
HOW DID YOU KNOW THE PRIZE? *
 
TERMS & CONDITIONS I declare to be aware and agree with all the norms of the Regulation of the Prize at http://www.artelagunaprize.com
   
PRIVACY * I accept what specified in the releasing for the use of the winning project of the Special Prize called "Pas de Rouge"
   
  I Autorize MoCa Association to use my information as the Italian Privacy Law 675/96 and D.Lgs. 196/2003, also for the purpose of inclusion in databases operated by The Organization.