dockarta zgłoszenia application card xvi międzynarodowy konkurs
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karta zgłoszenia application card xvi międzynarodowy konkurs
KARTA ZGŁOSZENIA APPLICATION CARD XVI MIĘDZYNARODOWY KONKURS CYFROWEJ FOTOKREACJI CYBERFOTO 2013 XVI INTERNATIONAL CONTEST OF DIGITAL PHOTOCREATION CYBERFOTO 2013 1. Imię i nazwisko / First name and surname ........................................................................................................... 2. Dokładny adres zamieszkania, kod, telefon, e-mail Exact address, postcode, telephone, e-mail ........................................................................................................... ……………………………………………………………………… 3. Sposób powstania pracy /technika, program graficzny, itp./ Artwork creation manner /technique, graphic program, etc./ ........................................................................................................... ........................................................................................................... 4. Godło / Emblem ……………………………………………………………………… ........................................................................................................... 5. Tytuły prac / Artwork titles ........................................................................................................... ........................................................................................................... ........................................................................................................... ........................................................................................................... ........................................................................................................... ........................................................................................................... ........................................................................................................... ........................................................................................................... ........................................................................................................... ........................................................................................................... Oświadczam, że jestem jedynym autorem prac zgłoszonych do konkursu. Osoby na fotografii zgodziły się na rozpowszechnienie ich wizerunku. Wyrażam zgodę na rozpowszechnienie moich danych osobowych dla reklamy konkursu. I hereby declare that I am the only author of the artworks submitted for the competition. The people depicted in the photograph have agreed to the dissemination of their image. I agree to the dissemination of my personal. ......................................................... podpis autora / author’s signature
