32 pagine dicembre nuovo.qxd - Gruppo Torsanlorenzo

Annex B
“TORSANLORENZO NURSERIES INTERNATIONAL PRIZE”
LANDSCAPE DESIGN AND PROTECTION
I the undersigned __________ , born in _____ __________
on___ __,citizenship ______ ______ address in____ _ _
street_______________ ____ __ number ______, tel.___________________
fax_____________ __ e-mail_____________ ___________in the role of group head
DECLARES
a) That he/she has have been enrolled on the Professional Register (OR EQUIVAlENT)
of the __________________________________________________ _____________
of the Province of ________________ ______as N°_____________ __ _
from__________________________;
b) That none of the incompatibilities cited in art. of the Prize Regulations
apply to this application;
c) (to be completed only if the candidate is a legal representative ) Indicate the
names of the collaborators and their professional qualification:
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
d) That he/she accepts all the Prize Regulations;
e) That he/she authorises, without limitation and free of charge, the dissemination
and publication of the design documents and the personal names and surnames
of the participants and collaborators.
Place _____________, date_______________
Signature
________________________
(Attach a photocopy of an identification document)
12
torsanlorenzo Informa