Partecipation form

To Project “La Cultura delle Culture”
Claudia Patruno per la Solidarietà

Walls and ditches, fords and bridges

first name / prenom:
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adresse:
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e-mail 
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Work title
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Chosen non-profit organization for your donation

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Date						Signature
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Release for use of images of your works
To Project “Culture of Cultures”
Claudia Patruno per la Solidarietà

 Walls and ditches, fords and bridges

A RomaCultura.it (Hochfeiler)
SEDE

	I, undersigned __________________________________________________, in reference to the request to leave my works to RomaCultura.it (Hochfeiler), allowing to use images non-profit, to be reproduced with any technique (paper, digital, web) in any way (DVD, Video, Web, etc.) for publications or other projects even after the end of this cultural event

DECLARES

To leave his works sent to RomaCultura.it (Hochfeiler), non-profit only;

to release the release form on condition that the images are used for the realization of the project, for activities such as exhibitions and editorial publications, and for cultural, didactic and educational purposes;

to consent to the use of the personal data provided, for the exclusive purpose of identifying the author, place and occasion of the photo (legge sulla privacy n.675/96, e d.lg. 28 dicembre 2001, n. 467).

Data ……………………………………….				Firma …………………………