APPLICATION FORM

I wish to apply for the following event:

3rd  Workshop
MARKETING & DISTRIBUTION
Modra, Slovakia
5 – 9 October 2009
□

Participation fee: 	600 Euros inclusive of accommodation and subsistence

DEADLINE:	 	4 September  2009	 Extended deadline: 18 September 2009 !!

Name …………………………………………………  	Surname ……………….………………………………         F / M

Nationality …………………………………………..……………..   Date of Birth………………..……..………………….

Profession………………………………………………………………………….………..…………..……………………

Production company (if applicable)…………………………………………….………..………………..………………….

Address………………………………………………………………………….…………………..…………………………..

Postal code ……..………..   City ……………………………………  Country………………….………………………….

Tel. ……………………………………………………    Mobile……………….…………………..…………………………

E-mail ………………………………………………….. Website…………………………………………………………….

please fill in with block letters and return by fax or e-mail with the following documents:

         	□   letter of motivation
         	□   curriculum vitae

After confirmation by Fabulafilm participants applying for the  workshop must also provide proof of payment of a registration fee of € 300,00 payable by international bank transfer to:

	Unicredit Banca – Roma Magna Grecia ‘A’ – Largo Magna Grecia 16/A – 00183 Rome – Italy 
Account: 		000010470244    FABULAFILM
IBAN: 		IT 41 R 03002 03247 000010470244
BIC SWIFT: 	BROMITRDXXX

Signature: ……………………………………………..…             Date: ……………………………………….