Application for participation in a contest for the carrying out of a research study on wine consumption in the emerging economies, sponsored by Slow Food Editore and Slow Food Promozione

Please fill in the application form clearly and legibly

To:

Slow Food Editore

Slow Food Promozione

12042 Bra (CN)

Fill in this box if it is an individual research project
The undersigned ______
born/ina ______(Prov. of _____) on______
Citizenship ______Permanent residence ______
Street name ______no. ____ Postal code ______
Telephone (land line) ______mobile no. ______E-mail address: ______
Enrolled in A.Y. 2013/2014 in the ___ year of the ______Degree Course
at the University of Gastronomic Sciences
Student number: ______
Fill in this box if it is a group research project
1° researcher
The undersigned ______
born/ina ______(Prov. of _____) on______
Citizenship ______Permanent residence ______
Street name ______no. ____ Postal code ______
Telephone (land line) ______mobile no. ______E-mail address: ______
Enrolled in A.Y. 2013/2014 in the ___ year of the ______Degree Course
at the University of Gastronomic Sciences
Student number: ______
2° researcher
The undersigned ______
born/ina ______(Prov. of _____) on______
Citizenship ______Permanent residence ______
Street name ______no. ____ Postal code ______
Telephone (land line) ______mobile no. ______E-mail address: ______
Enrolled in A.Y. 2013/2014 in the ___ year of the ______Degree Course
at the University of Gastronomic Sciences
Student number: ______
3° researcher
The undersigned ______
born/ina ______(Prov. of _____) on______
Citizenship ______Permanent residence ______
Street name ______no. ____ Postal code ______
Telephone (land line) ______mobile no. ______E-mail address: ______
Enrolled in A.Y. 2013/2014 in the ___ year of the ______Degree Course
at the University of Gastronomic Sciences
Student number: ______

HEREBY APPLY

To participate in the contest for the carrying out of a research project on wine consumption in one of the following emerging economies:

Brazil

China

India

Hong Kong

Russia

South Korea

And for this purpose declare(s), at his/her/their responsibility:

-that he/she/they are in good standing with regard to tuition payments and any eventual fees for room and board and meal plans

-that he/she/they is/are not now and have never been subject to any disciplinary sanctions

-satisfy the requisites for participation in the selection procedure as specified in the Contest Announcement.

The undersigned give(s) his/her/their consent to the treatment of their personal information in compliance with Legislative Decree n. 196/03, for purposes related to this contest.

The undersigned give(s) his/her/their consent to the utilization of the images (video and/or stills) realized during the course of the research project that is the object of this contest by Slow Food Editore and Slow Food Promozione for didactic and informational purposes (teaching materials, brochures, website, posters, publications, etc.).

The undersigned confirm(s) that they waive all rights to the material indicated above and hereby renounce irrevocably any and all rights, legal actions or demand deriving from the above authorization.

Place and date ______

Signature
______/ Signature
______/ Signature
______

UNSIGNED APPLICATIONS WILL NOT BE TAKEN INTO CONSIDERATION