REGISTRATION FORM TO REVIEW SHORT FILMS "Corto di Sera..."

The undersigned_______________________________________________________________

Adress________________________________________ City ______ _______________

Nationality _____________ e-mail _______________________________________________

Tel._________________________________

Intends to participate in the Festival of Short Films "Corto di Sera ...", with the following work:

Title: ______________________________________________________________________

Length (max 25 minutes): ____________

Director / s _____________________________________________________________________

____________________________________________________________________________

Original Music (yes / no) _____ Author: ____________________________________________

Year of production: _______

Material must be attached: SHORT FILM on DVD. SYNOPSIS / Presentation (maximum 5 lines)

NOTE: This material will not be returned and will be available to the Association.

Place and date: _________________________ Signature: ___________________________________

"Giovannello da Itala" Festival of Short Films "Corto di Sera..."VIA S. CATERINA, 25 – 98025 ITALA (ME) - VIA ROMA, 124 - 98025 ITALA (ME) TF

0909586022G. U. REGIONE SICILIANA N. 18 DEL 24.04.2008 DDG N. 158/S2TUR - 12.3.08 UNPLI 2013- 04526 C.F. E P. IVA 02925260834 www.prolocoitala.it Email: prolocoitala@pec.it - info@prolocoitala.it

DISCLAIMER

With reference to my participation in the exhibition "Corto di Sera ..." and the Legislative D. no. 196/2003 on the protection of personal data, I authorize the Association Pro Loco "Giovannello da Itala", the processing of my personal data.

The undersigned (name) _________________________________________________

It claims to be Director or Producer Short Film entitled:

____________________________________________________________________________

and to have full and exclusive rights.

Declares that it does not infringe the rights of third parties as expressed by the Law 633/1941 concerning copyrights.

Authorize a public screening of his short film for cultural purposes.

In addition, the undersigned pursuant to and for the purposes of Legislative Decree no. 196/2003 gives his consent to the processing of personal data, even with tools.

Place and date: _________________________

Signature: __________________________________

VIA S. CATERINA, 25 – 98025 ITALA (ME) - VIA ROMA, 124 - 98025 ITALA (ME) TF 0909586022

G. U. REGIONE SICILIANA N. 18 DEL 24.04.2008 DDG N. 158/S2TUR - 12.3.08 UNPLI 2013- 04526 C.F. E P. IVA 02925260834 www.prolocoitala.it Email: prolocoitala@pec.it - info@prolocoitala.it