CONCORSO TOGNI

CAT:*:

Family name:*:

Name:*:

Birth town:*:

Birth date:*:

Address:*:

Town:*:

Zip code:*:

Internation phone number:*:

E-mail::

Chosen Compulsory Pieces:*:

Free program: Chosen pieces.Name of the author an title:*:

Here attached - Birth certificate (or personal declaration of date of birth):
Yes
No

Receip of the Bank draft to Associazione Mousa (IT 44 Y035 0054 5910 00009528) Banco di Brescia - Gussago:
Yes
No

I declare to totally accept the competition regulation*:
Yes
No

Date:*:

Competitor signature:*:

Teacher signature:*:

teacher's family name and name:*:

Teacher's address:*:

Teacher's Town:*:

Teacher's zip code:*:

Teacheer's International phone number::

I autorize to treat the personal information as 675/96 low:*:
Yes
No