The undersigned
Born in (Prov. ) Country
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in possession of the following qualifications (indicate the qualifications obtained and/or the schools currently being attended)


REQUESTS
to be allowed to participate to the fifth edition of the Premio "Francesco Geminiani" which shall take place in Verona on the 19th and 20th May 2012 for the violins violas cellos

The applicant has chosen to perform the following pieces:
a piece with only one instrument according to one's choice:

a piece with piano accompaniment to be chosen amongst those proposed by the Jury:


The applicant would like to be accompanied by the Pianist put at disposal by the Prize:

YES NO

More informations (optional):





In the event of admission, the applicant undertakes to send the documents provided for by art. 5 of the regulations to the office of the Secretary of the Premio "Francesco Geminiani". Said documents are to arrive by the 26th April 2012. Failure to comply will result in exclusion from the competition. The applicant declares to have looked over the Prize's fifth edition regulations published on the web site www.premiogeminiani.org and to accept all its clauses and conditions.

According to art.13, Legislative Decree 3rd June 2003 No. 196, the applicant authorizes the use of his/her own personal details needed for the competition. The data will be kept by the Association's President in office. It is possible to access the data or require its cancellation by writing to Associazione Premio "Francesco Geminiani" - Via Carlo Cattaneo n. 26 - 37121 Verona.