Segreteria Concorso Pianistico Internazionale “Arcangelo Speranza”

MODULO DI ISCRIZIONE - APPLICATION FORM - FORMULAIRE D’INSCRIPTION - ANMELDEFORMULAR
Il modulo di iscrizione corredato dei seguenti documenti dovrà essere spedito al seguente indirizzo
The application form together with all documents required must be returned postmarked to the following address
Le formulaire d’inscription, accompagné de tous les documents nécessaires, devra être retourné à l’adresse suivante
Bitte in Maschinen or der Druckschrift ausfüllen mit den erforderlichen Unterlagen an die folgende Adresse einsenden
Segreteria Concorso Pianistico Internazionale “Arcangelo Speranza”
info: [email protected] - tel. (+39) 099.730.39.72
Dati anagrafici - Personal data - Reinsegnements personnel - Personalien
1. ___________________________________________________ ______________________________________________ MF
Cognome - Surname
Nom de famille - Familienname
Nome - Name
Prénom - Vorname
Sesso - Sex
Sexe - Geschlecht
2. ______________________________________________________________________________________________
Data e luogo di nascita - Date and place of birth - Date, Lieu, Pays de naissance - Geburtsdatum und Ort
3. ______________________________________________________________________________________________
Nazionalità - Nationality - Nationalité - Staatsangehörigkeit
4. ______________________________________________________________________________________________
Foto - Photo
2. ______________________________________________________________________________________________
Recapito permanente - Permanent address - Adresse permanente - Heimatadresse
5. ___________________________ ____________________________ ____________________________________
Telefono - Telephone
Téléphone - Telefon
Cellulare - Mobile phone
Portable - Mobile
E-mail
5. __________________________________________________________________________________________________________________
3. __________________________________________________________________________________________________________________
Studi Musicali - Musical education - Études musicales - Musikalische Ausbildung
A. Scuola - School - Écoles - Lehrer
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Nome della scuola - Name of the school
Nom de l’école - Name der Schule
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Insegnanti - Teachers
Professeurs - Lehrer
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Periodo - Year attended
Période d’étude - Zeitraum
B. Masterclass/Borse di studio - Masterclasses/Scholarship - Masterclasses/Bourses - Meisterklassen/Lehrer
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Periodo di studio - Date of study
Période d’étude - Zeitraum
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Insegnanti - Teachers - Professeurs - Lehrer
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Città - City - Ville - Stadt
C. Concorsi - Competitions - Concours - Wettbewerbe
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Anno - Year - Année - Jahr
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Nome del Concorso- Name of the Competition
Nom du Concours - Name des Wettbewerbs
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Piazzamento - Placement
Classement - Preis
D. Insegnante privato - Private theacher - Professeur particulier - Privat Lehrer
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Programma per le prove - Program - Programme - Programm
A. Prova eliminatoria - Preliminary round - Éliminatoire - Vorrunde
Durata - Timings
Durée - Dauer
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B. Prova semifinale - Semi-final round - Demi-finale - Semifinale
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D. Prova finale - Final round - Finale - Finale
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Data - Date - Date - Datum ___________________________
Firma - Signature - Signature - Signatur ____________________________________________