Mr Mrs Miss

EXSPORT MOVIES & TV 2015 33rd MILANO INTERNATIONAL FICTS FEST REGISTRATION FORM VIP AND PRESS ACCREDITATION

Space reserved to VIP ACCREDITATIONMr Mrs First Name Last Name

Network / Company Job position

Address City

Zip Code Country

Phone Fax E-mail

Direct phone Mobile Website

Space reserved to PRESS ACCREDITATION

OVERNIGHT STAY 27/10 28/10 29/10 30/10 31/10 1/11 2/11 IN MILAN

What kind of event of “Exsport Movies & Tv 2015” do you like attend?

Heading:...... OPENING CEREMONY (28 OCTOBER) TypePROJECTION, of press: WORKSHOP PressAND MEETING Radio (29 - 31 OCTOBER Press Agency) Web Other AWARD CEREMONY (1 NOVEMBER)

Position: Journalist Photographer Technician Other

The present must be sent back to the FICTS within 28th OCTOBER 2015 by mail to [email protected] or by Fax (+39) 02.837.59.73

According to and for the effects of the Art. 13 of the legislative decree number 196 of 30th June 2003, the personal data will be dealt, exclusively in the within of the procedure for which the present declaration is make.

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