Adatlap

PATCHWORK  ki�ll�t�shoz

2021.

A jelentkez� adatai:

N�v:                                                                                                                                               

C�m:                                                                                                                                               

Telefonsz�m:                                                                                                                                 

E-mail c�m:                                                                                                                                    

Csoport:                                                                                                                                         

A p�lyamunka adatai:

C�m:                                                                                                                                               

M�ret:                                                                                                                                            

K�sz�t�s �ve:                                                                                                                                 

Technika:                                                                                                                                       

Reprodukci�-e?:           igen / nem                (k�rj�k al�h�z�ssal jel�lni)

Reprodukci� forr�sa:                                                                                                                     

Visszak�ld�s m�dja: (k�rj�k al�h�z�ssal jel�lni)

·                     Szem�lyes �tv�tel

·                     Helysz�n: H�r�s Ag�ra Kultur�lis K�zpont

                (6000 Kecskem�t, De�k Ferenc t�r 1.)

·                     Postai �ton a p�ly�z� c�m�re

Kelt: ………………………………….., 2021. ……………………. h� ……… nap

                                                                                                        ..............................................

                                                                                                               A jelentkez� al��r�sa