REGISTRATION FORM

The International courses Archi in Villa Baruchello – Summer Music Masterclasses – are open to musicians of all nationalities, without age limits who are members of the Cultural Association Club della Musica . To become a member of the Association, simply fill in the registration form and mark the appropriate registration box.

Info : info.archiinvilla20@libero.it tel/phone +39 3357313490

FILL-IN AND SEND

STUDENT DETAILS

Surname and First Name
Sex FM
Date of birth
Nationality
City
CODE
Country
Street
Number
Telephone
E-mail
Tax identification number

FOR FOREIGNERS ONLY

Identification document n.
Issued on
Issued by
Valid until
Healt service card

ADHESION TO CLUB DELLA MUSICA ASSOCIATION

check one of the two boxes:
A - I ask the Board to be registered as a member of this association: Cultural Association CUB DELLA MUSICA via dei Mille n. 14 - 63821 Porto Sant'Elpidio (FM) – ItalyB For the child under age I ask the Board to be registered as a member of this association: Cultural Association CUB DELLA MUSICA via dei Mille n. 14 - 63821 Porto Sant'Elpidio (FM) – Italy

MASTERCLASS

Indicate your musical instrument
Musical qualifications
Taken at
Conservatory or musical institute actually attended:
Course

I WOULD LIKE TO BE ENROLLED IN

Select Masterclass

Paolo Vergari pianoforteDante Milozzi + Maria FabianiSusanna Bertuccioli arpaRiccardo Crocilla clarinettoMarco Salvatori oboeAlejandra Rojas Garcia fagottoPaolo Valeriani cornoDora Bratchkova e Andrea Saxer violinoGerhard Muller violaAlina Kudelevic violoncelloFedele Antonicelli pianoforteMarco Rapattoni pianoforteDanilo Formaggia canto lirico

As:
ActiveObserver

For active participants:
Medium levelHigh level

Chamber Music only 22-23-24 July with Marco Salvatori:
DuoTrioQuartet
Chamber Music only 17-23 August with RASUMOWSKY QUARTETT BERN:
DuoTrioQuartet

Participation in COMPETITION FOR PARTICIPATION WITH SCOLARSHIP “RASUMOWSKY-QUARTETT”
( Request Deadline June 15th 2020 )
YesNo

music score for which you require a piano accompanist
(deliver the music sheets 30 days in advance to the address ">info.archiinvilla20@libero.it)

List of pieces prepared for the masterclass

Reservation for accommodation in Convention (if yes, please express your preference)
YesNo

Participation in music improvisation workshop - basic level - M° Roberto Zechini (8 hours - 45 euros)

DOCUMENTS TO ATTACH

ATTACHMENTS:
I enclose copy of identification document, copy of the proof of payment (the present enrollment will be invalid unless the proof of the payment is attached):
Identity card - front
Identity card - back
Receipt of payment

In case of a minor registered:

Data of both parents exercising parental responsibility or parent data that exercises it exclusively

FATHER'S INFO

Surname and First Name
Date of birth
Nationality
City
Country
CODE
Street
Number
Telephone
E-mail
Tax identification number

MOTHER'S INFO

Surname and First Name
Date of birth
Nationality
City
Country
CODE
Street
Number
Telephone
E-mail
Tax identification number

Release for Minors completed end submitted here
donwload here
Release for Minors

For the minor child I AGREE I have read and understood the release document for Minors

Accept terms and Conditions Masterclasses
I declare to have read and accept the Rules of Villa Baruchello Summer Academy

Privacy Consent
Information pursuant to the GDPR-EU Regulation no. 679/2016 With this I authorize the Cultural Association Club della Musica to use, in accordance with Regulation GDPR-EU n.679 / 2016, personal data only and exclusively for institutional purposes, connected or instrumental to the activity of said Association and in particular for sending informative material related to the activity of the same. Furthermore, it is always possible to exercise the rights referred to in Regulation GDPR-EU n.679 / 2016, including the right to access data and obtain the update or cancellation without delay. Leggere Informativa sulla Privacy
I read and give consent

PAYMENTS

METHOD OF PAYMENT OF THE REGISTRATION FEE

The application fee is 70 euros. Discount 30% for those who register by May 31: euro 49.00

Payment of the Application Fee must be made by bank transfer to the following account:

name of the bank

CASSA DI RISPARMIO DI FERMO

63821 Porto S.Elpidio Italia

Account info

IBAN IT59W0615069670CC0160101419

BIC SWIFT CRFEIT3FXXX

Account Holder

Associazione Culturale CLUB DELLA MUSICA

Via dei Mille n.14 – 63821 Porto S. Elpidio (FM) – Italia

specify in the reason for the transfer:

name and surname of the member of the course;