24 HOUR COMICS DAY 2012

Sala Polivalente – Via Sabbioni
Villanova del Ghebbo (Ro) 1 ottobre 2011

Scheda di iscrizione
[ ] 24 HIC

[ ] 2,4 Ore

barrare la casella interessata

Nome: ______________________________________
Cognome: ___________________________________
Eventuale pseudonimo o nome d'arte: ______________________________________
Data di nascita: _______________
Indirizzo: __________________________________________

Telefono: ____________________

Fax: __________________

Cellulare: ___________________
e-mail: ____________________________

Sito Web: _______________________

Social Network: _____________________

Blog: ___________________________

BIOGRAFIA / curriculum
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Pubblicazioni:
________________________________________________________________________________
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Altro:
________________________________________________________________________________
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Eventuali intolleranze o regimi alimentari particolari: __________________________
________________________________________________________________________________

Compilare questa scheda e inviarla via e-mail a: info@deltacomics.it
oppure comicstrip@libero.it
oppure fax: 0425 23988
Allegare propria fotografia/immagine/ritratto in formato jpg (facoltativo)

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