Entry Form

by Super User
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Surname………………………………………………………………………………

Name……………………………………………………………………………………

Nickname for catalogue: …………………………………………………………………………………………...

Date of birth: ………………………………………………………………………

Address……………………………………………………………………………….

C.A.P. –

City: …………………………………………………………………………

Phone Number: …………………………………………………………………

E -mail………………………………………………………………………

I declare to possess the absolute property of all the images sent and their components, I attest to the accuracy of the information provided, I accept in all its parts the rules of this competition.

Date: ………………………………………….

Sign: ………………………………………………………………………………

(I authorize the processing of personal data contained in this application form based on Article 13 of Legislative Decree 196/2003 and Article 13 of EU Regulation 2016/679 concerning the protection of individuals with regard to processing of personal data.) List of presented illustrations (if a title is not given for the works sent, they will be listed in the catalog with the title of the "Coast to Comix" competition):

1 – Title: ……………………………………………………………………………………

2 –Title: ……………………………………………………………………………………

3 –Title: ……………………………………………………………………………………