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REGISTRATION FORM

Sede: Rua Figueira da Foz n 40 3090-495 Paio, Portugal E-mail: aaagp.international@gmail.com Blog: http://aaagp-portugal.blogspot.com/ http://premiomariosilva.blogspot.com/

Name & Surname: Artist Pseudonym:


(if applicable)

Address: Postal code: Mobile Phone: Phone: State /Country:


Email

City/Town

Date of birth: The insured value of the art-work/s: - 1st - 2nd

Other information:

Artwork(s) data(s): title/technique/size/price

Artwork n 1:

Title: Technique: Size(cm): Price:

Artwork n 2:

Title: Technique: Size(cm): Price:

Date:

Signature:

I agree to comply with all the Regulations of the Mrio Silva Prize

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