Application for participation

Author’s full name/date of birth_______________________________________

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Place of employment/education institution______________________________

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Full name, occupation, degree (in full) of the art supervisor (for the students)___________________________________________________________

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Postal address (specifying country and residential zip)____________________

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Phone number/e-mail______________________________________________

Title of the work(s), year of creation___________________________________

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Technique, size _____________________________________________

Specific explanations, if any

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I agree with the terms of participation

 

Date_________________________Signature_________________________