ENROLMENT FORM

Surname

Name

Place and date of bith

Address

Tel Fax Mobile

E-mail

N.passport or identity card

Profession

Type of camera you will use


You want to shoot:
in black and white
colour
both

Accommodation:
in agriturismo
in hotel
in house: single room double room sofa bed

Title of workshop and teacher	Workshop cost	Total
A journey into the Sicily of Giovanni Verga with Giuseppe Leone
	Less deposit enclosed
	Balance due 15 days prior to start of workshop

Method of payment: wire transfer

I declare I have carefully read the workshops rules concerning the modality of payment, insurance, cancellation and refunds and I agree to the terms and conditions.

The enrolment form correctly filled in should be send by fax to the following number 0039/081/7690606 enclosing the copy of the deposit receipt.

ass.culturale
obiettivo granieri
poggio castel granieri
piazza silvestri n. 2
caltagirone (ct)
tel +39.0933.330001
cell +39.338.7893908
info.obiettivo
granieri@gmail.com