Kidney Infectiongo Back Work

FORM to participate in the I INTERNATIONAL CONTEST Of mimetic art (fill in capital letters, sign and attach to the back of the work that is sent.)

NAME: SURNAME

:

DATE OF BIRTH: PLACE OF RESIDENCE

:

ADDRESS: PHONE

:

EMAIL:

DNI or passport:

TITLE WORK TO BE ATTACHED:

MEASURES:

TECHNIQUE:

SIGNATURE OF AUTHOR:

METACERT Menes F

I wish to participate in the International Choir Festival of mimetic art and certify that the above work is original and my responsibility, and does not infringe rights of third parties and has not been awarded other prizes or competitions. I have read, know and fully accept the above BASES Contest organized by the Association for Equality artists.