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Ficha

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  • 1. MARATÓN CREATIVO 2010 FICHA DE INSCRIPCIÓN Nº: TIPO DE PARTICIPANTE: AMATEUR PROFESIONAL NOMBRE COMPLETO DEL AUTOR: ................................................................................. FECHA DE NACIMIENTO: ..................................NACIONALIDAD: ................................... Nº y TIPO DE DOCUMENTO: ....................................TEL: ..................................................... DIRECCIÓN : ............................................................................................................................... LOCALIDAD: .................................................................................................................... ……. E-MAIL : ........................................................................................................................................ DISCIPLINA: ................................................................................................................................ TÍTULO DE LA OBRA: ............................................................................................................... TÉCNICA APLICADA: ................................................... DIMENSIONES: ........................... TIEMPO ESTIMADO DE ELABORACIÓN: ........................................................................... OBSERVACIONES SOBRE ESPACIO Y UTILIZACIÓN DEL MATERIAL PROPIO DE LA OBRA: .......................................................................................................................................................... BREVE CURRICULUM VITAE DEL AUTOR: …………………………………………… .......................................................................................................................................................... .......................................................................................................................................................... La/ El abajo-firmante declara haber leído las Bases del Maratón Creativo y estar de acuerdo con las mismas. LUGAR Y FECHA:……........................................ FIRMA Y ACLARACIÓN: Alliance Française San Luis Argentina - Chacabuco 634 - 5700 San Luis Tel. 0054- 2652- 432441 Email. afsanluis@gmail.com Web. www.afsanluis.com.ar
  • 2. Alliance Française San Luis Argentina - Chacabuco 634 - 5700 San Luis Tel. 0054- 2652- 432441 Email. afsanluis@gmail.com Web. www.afsanluis.com.ar