Registration form International Contest SAV 2014

Registration Form 2nd INTERNATIONAL CONTEST SPORT AGAINST VIOLENCE 2014 The undersigned Resident in ________________________________________________ street/square ______________________________________________ Cell Phone _________________________________________________ e-mail _____________________________________________________ DECLARES TO WANT TAKE PART IN THE INTERNATIONAL CONTEST Sport Against Violence SAV 2014 "Resistance and Resilience" and sends the following works: Photography Section TITLE 1 ___________________________________________________________________ TITLE 2 ___________________________________________________________________ Unpublished short story Section TITLE _____________________________________________________________________ Video Section TITLE _____________________________________________________________________ * If you want you can make a brief description of each work submitted, providing the necessary data relating to the time, place, portrait, or other that can be useful in the evaluation. Declares to accept the rule in all its parts, in particular: • to own all the rights of copyright on original works submitted; • to be personally responsible for the subject matter of the works presented; • to retain ownership of the works submitted to the jury, giving free unlimited rights to use the images and their further processing at Libera Accademia di Roma LAR, Università Popolare dello Sport UPS and Sport Against Violence SAV for all institutional purposes to be established; • to have the free right to use and disclosure of the material submitted, and raised from any damages arising from the publication and/or use of the material in violation of the rights of third parties, including pursuant to Legislative Decree 196/03; • to waive the right of restitution of the works submitted. N° identity document ________________________________________________ I authorize the processing of personal data pursuant to Legislative Decree 196/03 Date ........................... SIGNATURE

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