APPLICATION FORM

INSTRUCTIONS FOR THE CORRECT APPLICATION TO THE 15th EDITION 

Just completed, this form, you will receive it to the email address included.

A printed copy in paper form must be signed and will be send with the material related to the shortfilm.

Spaces marked with (*) are required

DIRECTOR'S INFO
Name* Nationality*
Date and Place of birth* Address*
Town* Zip code*
Telephone* Fax
E-mail* Web site
PRODUCTION COMPANY DATA
Institution Name Address
Town Zip code
Telephone Fax
E-mail
SYNOPSIS OF THE SHORT FILM
I authorize that a copy is deposited in the archives of video MOMPEO IN CORTO for public consultation, exhibition, cultural and educational non-profit organization YES NO
ATTACHED MATERIALS
Video DVD MiniDVD
Material in print Poster
Photo Press Book
Video Link *
REGISTRATION FORM
Title Original Production* Year *
Country of production* Duration *
Work first* YES NO            
Genre* Fiction Experimental Documentary Animation Music Videos
Screen Format* Standard 4:3 Panoramic 16:9 iPhone 3:2
Dialogues* YES NO Language
TECHNICAL
Script Photography
Music Sound
Cut Cast
DISCLAIMER
The undersigned * Nationality *
Date and Place of Birth: * Resident *
Address * Zip code */b>
Phone * Fax
sends to the Competition "MOMPEO IN CORTO" - 15th edition, the short film named:

Aware that whoever makes false statements is punishable under the Penal Code andspecial laws, pursuant to art. 76 DPR No. 445/2000 and subsequent amendments: It claims to be the author of the short film described above and to have total and exclusive legal rights;

Declares that his short film does not infringe the rights of third parties, as expressed by the law 633/1941, as amended (the copyright), and not contain content that is defamatory; It claims to have read and understood and therefore fully accept all the Competition Rules "Mompeo in Corto" 15th edition;

Authorizes that a copy is deposited in the archives of the video "Mompeo in Corto" for public consultation, exhibitionand cultural education, not for profit;

Authorizes Screenplay, Storyboard, and all materials submitted, will be published(with citation of authors) in the festival site or linked to cultural-educational and promotional purposes without further compensation;

Authorizes the public showing of his short film without any payment by the City ofMompeo;

Allows streaming of the Short Film Festival posted on the site, without compensation;

Authorizes the broadcast TV (terrestrial, satellite, digital, web, TV, etc..) the entire short film sent, for promotional purposes without further compensation;

Declares to be aware of the penalties in case of false statements.

Moreover, the undersigned, under Article 10 of Law 675/96 and to Art. Leg 13. No.196/03 as amended, declares to be fully informed of the purpose and methods of processing the data given in this sheet and gives its consent to the processing ofpersonal data received, even by computer.

Credits: GreenConsulting Srl

Direzione Artistica: Maria Luisa Lafiandra

Per informazioni ed iscrizioni: info@festivaldelcorto.org

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