Laboratori
www.traccedimemoria.net
[email protected]
+39 349 32 81 556
+39 339 71 04 051
A village and its residents. Recollections, tales, traces of memory.
“TRACES OF MEMORY”
RESIDENTIAL WORKSHOP FOR DANCERS IN MONTALBANO ELICONA (ME)
DIRECTED BY
SARA ORSELLI
FROM
COMPAGNIA CAROLYN CARLSON
28 May – 6 June 2017
Attachment 7 – Appearance and produced material Release
I, the undersigned,
Name and surname
Place of birth _________________________Date of birth _______________________________
Address ________________________________________________________________________
Postal Code ___________________________Telephone number ___________________________
Email address (in block letters) ______________________________________________________
www.traccedimemoria.net
[email protected]
+39 349 32 81 556
+39 339 71 04 051
Laboratori
[ ] I give my consent to the processing of my personal data pursuant to the law L. 675/96
(D.L.30/06/2003, n. 196)
[ ] I give my consent to record my image in photos and videos and to use any of the material for
the purpose of documenting the project on social networks, media, websites and hard-copy
documents dedicated to it. I give my consent to the transmission of any of the material to press
organisations and other websites for dissemination and/or educational purposes or for every
other use considered appropriate by the organisation for the matters relating to the project
“Tracce di Memoria”. I understand that I will not be compensated in any way and that the
recording and/or use of my image is to be considered for free.
[ ] I give my consent to the use any of the material produced and realised by myself during the
activities provided by the Announcement, for the purpose of documenting the project on social
networks, media, websites and hard-copy documents dedicated to it. I give my consent to the
transmission of any of the material produced and realised by myself to press organisations and
other websites for dissemination and/or educational purposes or for every other use considered
appropriate by the organisation for the matters relating to the project “Tracce di Memoria”.
I understand that I will not be compensated in any way and that the use of the material produced
by myself is to be considered for free.
Place and date
Signature