---

---

4 Hands Piano   Duo-Instruments

   Ensemble - Formation

Category Junior A     B    C   D   E

1st Player Surname and Name (or Conductor)

place of birth  date of birth  / /
 
instrument

full address 
   
e-mail     Teleph. Numb. 

2nd Player Surname and Name

place of birth  date of birth  / /
 
instrument

full address   
 
e-mail     Teleph. Numb. 

Teacher/s (Surname, Name, Full Address, Tel. Numb.and e-mail):

Programme
(Composers,Titles and Time)

We enclose:
1)Birth Certificates or self - certifications.

2) Copy of the receipt of the Application Fee of
80 Euros (4 Hands Piano - Duo) or of 110 Euros (Ensemble),
payable in one of the following ways:
a) by bank transfer entered to:
Banca Popolare di Bari - Filiale di Barletta via Ferdinando d'Aragona n. 173 - Barletta
c/c n. 1000866 ABI 05424 CAB 41350 CIN D
IBAN: IT33 D054 2441 3500 0000 1000 866
BIC : BPBAIT3BXXX
b) by non Transferable Cheque or Telegraphic Money Order made out to:
Associazione Cultura e Musica - G. Curci via P.Mascagni,1 70051 Barletta (BA) - Italia

3) Players List with Surnames, Names, Instruments and Full Addresses
We read and accept the Rule of the Competition.
We authorize the Associazione Curci to use these personal data for the Competition  necessities.
 Date / / Signature/s........................................................................................................................
Parent signature for minors................................................................................................
________________________________________________________________________________
N.B.:You can copy this application form by typewriter or photocopier.
The deadline for sending the application form is March 31, 2010 to:
"Associazione Cultura e Musica - G.Curci" Via Mascagni,1 70051 Barletta (BA) ITALY
_______________________________________________________________________________