APPLICATION FORM
deadline: 30th June 2021
to be sent together with your work to this email address:
associazioneculturale@clementinaborghi.it
Surname …………………………………………………………………………..
First Name ……………………………………………………………………………..
Place and D.o.B. ……………………………………..
Address ……………………………………………………………………………
Tel ………………………………… e-mail ………………………………………………………
Selected section
- Poetry – title ……………………………………………………………..
- Prose work – title ……….…………………………………………………
Pseudonym ……………………………………………..……………
I declare that the work submitted has been produced by me without any assistance
I, the undersigned, give my consent to the processing of data by Clementina Borghi Cultural Association for the purposes of the competition in which I partecipate
I also agree to accept the rules of the competition
Candidate’s signature ………………………………………………………………………….
Surname and name of the person exercising parental authority
………………………………………………………………………………………..
Parent’s signature ………………………………………………………………………
The candidate and the person who exercises parental authority also agree to accept the rules of the competition
Documents to be attached for the JUNIOR section
The work should be submitted in PDF format under the chosen pseudonym