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mod. 035 INTERNATIONAL ACADEMY OF MODERN ART Secretariat of the Presidency - Rome (Aurelio) Giulio
Sacchetti,10 Street - P.C. 00167 ON. PRESIDENCY I undersigned................................................................................................born the................................................... on (nation)..........................................................................city.................................................................................. with the residence to..................................................................................................................................................... and address....................................................................................................post code............................................ phone n...........................................................................fax n................................................................................ E.Mail............................................................................. provided of the following titles (1): ................................................................................................................................ having participated to the following demonstrations (2) ................................................................................................. ..................................................................................................................................................................................... and having achieved the following recognitions (3)......................................................................................................... ..................................................................................................................................................................................... with echoes of chronicle (4)......................................................................................................................................... .................................................................................................................................................................................. He/She ASKS of have counted in the Register on the «Corresponding Partners» of This Academy, to the Class (first/second) (5) and to the Category (6)................................... Date.....................................................................
Yours.....................................................................................................................
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¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤ (1) point out cultural titles, academic, professional. |
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A.I.A.M. Via Giulio Sacchetti,
10 |