Registration form

Name - Surname:

Date of birth:

Nationality:

Address, Street, City, postal code, Country:


Telephone::

E-mail:

Previous studies:


Indicate languages known:


Admission request for the following course/s
Peter Skubic
Rita Marcangelo
Maria Rosa Franzin & Graziano Visintin
Yutaka Nagai
David Loepp
Mari Ishikawa
Paola Pontiggia-Patrizia Bonati
GianCarlo Montebello
Michele Zanin


I ACCEPT:
Cancellations must be sent by registered letter within 30 days prior to the beginning of the course. You will be entitled to a partial refund of the amount paid (50%) from which any bank charges and postage fees incurred will be deducted. The insertion of your personal details on the agc database implies the acceptance of the following condition: within the meaning and the effects of Law 196/03 on the protection of personal data "I hereby expressly authorize agc to process, store and insert into the database all the data contained on this page." The undersigned assumes responsibility for all the data entered in the form. If for any reason the course/s were to be cancelled the subscribers will be reimbursed the total fees paid.

YES





Once you have filled-in the form and made payment, please send the payment slip via mail with a photocopy of your id document to the project manager Patrizia Bonati, Via Sicardo 12b - 26100 Cremona, Italy.



Swift bank details:

Agc Associazione Gioiello Contemporaneo
Unicredit Bank - Cremona Branch
P.zza Roma 2

Payment from abroad
IBAN: IT28P0200811400000040371440
CODICE BIC SWIFT : UNCRIT2B320
Payment from Italy
C/C 000040371440
ABI : 02008
CAB: 11400
CIN Italia: P
CIN Europa: 28
IBAN: IT28P0200811400000040371440

Please specify the name and surname of the subscriber and the name of the course teacher (compulsory)

example: John Smith subscribes to Peter Skubic's course