Richiesta di accredito / Registration Request Form

*Campi obbligatori / Required information

INFORMAZIONI PERSONALI / PERSONAL INFORMATION

NOME / FIRST (& MIDDLE) NAME*

COGNOME / FAMILY NAME*

SESSO / GENDER* (1)
M      F

DATA DI NASCITA / DATE OF BIRTH* (1)
giorno/day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   mese/month 1 2 3 4 5 6 7 8 9 10 11 12  anno/year 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909

E-MAIL*


Per cortesia controllare che l’indirizzo sia corretto.
Please check again your e-mail address.

WEB

TEL. (casa / home)*

TEL. (lavoro / work)

FAX

OCCUPAZIONE / OCCUPATION

ENTE RAPPRESENTATO / INSTITUTION or JOURNAL


Gli studenti devono indicare università e corso di laurea.
Students should indicate University and course of study.

RECAPITO POSTALE / MAILING ADDRESS

ENTE / ORGANIZATION


Compilare solo se il recapito postale prescelto è quello del luogo di lavoro.
Fill in only if you choose your office as mailing address.

VIA / STREET*

CAP / ZIP*

CITTÀ / TOWN*

PROVINCIA / COUNTY or STATE*

NAZIONE / COUNTRY*
Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard And Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italia Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea (People's Republic Of Korea) South Korea (Republic Of Korea) Kuwait Kyrgyzstan Lao People's Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts And Nevis Saint Lucia Saint Vincent And The Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia And The South Sandwich Islands Spain Sri Lanka St Helena St Pierre and Miquelon Sudan Suriname Svalbard And Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda UK Ukraine United Arab Emirates Uruguay USA Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis And Futuna Islands Western Sahara Yemen Zaire Zambia Zimbabwe Other Not Shown

ULTERIORI INFORMAZIONI / FURTHER INFO

NB. Questa è solo una richiesta di accredito. Se la vostra richiesta sarà accolta, entro pochi giorni riceverete entro il 31 luglio 2010 il modulo per essere accreditati alle Giornate 2010. / This is just a registration request. If your request is accepted, by thj the end of July 2010 you will receive an e-mail with instructions to access the 2010 Giornate on-line registration form.


    

(1) Vi chiediamo questo tipo di informazioni sia a fini statistici sia perché ci permettono di aiutarvi qualora abbiate bisogno di assistenza per l'alloggio durante lo svolgimento del festival.
Why do we require this information? Because it enables us to give proper advice to visitors looking for accommodation in the Pordenone area during the festival. Besides it is useful for statistics purposes.