MODULO DI DOMANDA
APPLICATION FORM

Cognome (Family name)______________________________________________
Nome (First name)___________________________________________________
Sesso (Sex)________________________________________________________
Data e luogo di nascita (Date and place of birth) __________________________
Cittadinanza (citizenship)_____________________________________________
Educazione Musicale (Musical education)________________________________
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Insegnanti, si prega di indicare nome, cognome, primo e gli altri nomi, premi onorari (Teachers, please indicate full name,honorary awards)______________
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Partecipazione a concorsi, premi, riconoscimenti (Participation in competitions, prizes, awards)______________________________________________________
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Indirizzo di residenza con il codice postale, telefono, fax, e-mail (Home address with postal code, contact telephone, fax, e-mail)___________________________
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PROGRAMMA (PROGRAM) ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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Le confermo che sono a conoscenza delle condizioni del concorso
e accettare l'obbligo di portare a compimento.
I hereby confirm that I am aware of the conditions of the competition
and accept the obligation to fulfill them.

Firma (Signature)____________________________________________________
Data (Date)_________________________________________________________