AFC - Enrolment Form - International Piano Competition "Rome 2009"



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ENROLMENT

I/We wish to join the Associazione Culturale "Fryderik Chopin" for the year 2009 and to participate to the 19th International Piano Competition "Rome 2009"

APPLICATION FORM :

Surname:

First Name:

Date of birth:

Place of birth:

Address:

Town:

ZIP Code:

State:

Code:

Telephone:

Fax:

E - Mail:

Note Applicants to the Competition 2009 in Duo sections are kindly requested to fill in also the following form:

APPLICATION FORM (only for duo):

Surname:

First Name:

Date of birth:

Place of birth:

Address:

Town:

ZIP Code:

State:

Code:

Telephone:

Fax:

E - Mail:

TEACHER:

Surname:

First Name:

Address:

Town:

ZIP Code:

State:

Code:

Telephone:

Fax:

E - Mail:

Herewith inclosed I/we 'll send:

1) Birth certificate*	1	2	(only for duo)
2) Nationality certificate*	1	2	(only for duo)
3) Recent photo	1	2	(only for duo)
4) Receipt of payment of the social fee 2009 and of the extra contribution for the Competition 2009 (art. no. 6 of the Association's Statute)
5) The program that I / we present with indication of editors and possible revisers of the music;
*Also a copy of a valid passport will be accepted.

I / we declare to accept unconditionally and without any reserve the rules of the Association's Statute and those of the Competition, with reference to the present application.

I/we will pay:


	Euro 80 for the soloists section A (for those born from and including 1990 onwards): Euro 50 as social fee 2009 and Euro 30 as extra contribution to the Competition;

	Euro 80 for the soloists section B (for those born from and including 1984 onwards): Euro 50 as social fee 2009 and Euro 30 as extra contribution to the Competition;

	Euro 110 for the section four-hands duo (for those born from and including 1975 onwards): Euro 50 for each person as social fee 2009 and Euro 10 for each duo as extra contribution to the Competition;

	Euro 110 for the section two pianos duo (for those born from and including 1975 onwards): Euro 50 for each person as social fee 2009 and Euro 10 for each duo as extra contribution to the Competition;

	Euro 90 for the soloists section "Chopin" Prize (for those born from and including 1975 onwards): Euro 50 as social fee 2009 and Euro 40 as extra contribution to the Competition;

The social fee 2009 and the extra contribution for the Competition 2009 are not refundable in any case. The payment must be done by means of bank transfer to:

Associazione Culturale "Fryderyk Chopin"
Banca Intesa - San Paolo - Ag. no. 03807
Via della Seta, 10 - 00144 Rome (Italy)
account no. 0626 / 81150129
ABI: 03069 - CAB: 03392 - CIN: U
IBAN CODE: IT35 U030 6903 3920 6268 1150 129
BIC CODE: BCITITMM

indicating in the motive:
"Social fee 2009 to the Association and extra contribution to the Competition 2009 "

Treatment of personal information
I declare to be informed about the use of both my personal information and my rights with document "privacy" on this web site, according to the D. Lgs. 30th June 2003 no. 196 and to have given my permission to their treatment by the Owner (the Associazione “F. Chopin”) and by the other legitimated subjects, for the carrying out of the Association’s activity. For this purpose the permission is obligatory..

Information about privacy
We remind you that in any moment you can exercise your rights according to article 7 of the D. Lgs. 30th June 2003 no. 196, for instance, our confirmation upon request of the existence or not in our archives of any your information, their updating, correction, completion or cancellation.

Associazione Culturale Fryderyk Chopin
Via Pierfranco Bonetti, 88/90 00128 Roma Tel. e Fax: +39 06 5073889 E-mail: info@chopinroma.it

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