9º PRÊMIO NABOR PIRES CAMARGO – INSTRUMENTISTA
FICHA DE INSCRIÇÃO – 2010 (Preencher de forma legível)
Nome do candidato: _________________________________________________
CPF: ______________________ RG: _______________________
Pseudônimo: ________________ Instrumento:_________________
E-mail: _________________________________ Telefone:__________________
2.Endereço:
Rua (Av.): __________________________________________________________
Número: _____________ Complemento:_________________
Bairro: ______________________ Cidade: _____________________
Estado: ______________________ CEP: _______________________
Distância percorrida: ______________km
3.Músicas:
3-1 Música de Livre Escolha:
Título: _______________________________
Autoria: ______________________________
3-2 Música de Nabor Pires Camargo: ________________________________
4.Acompanhantes:
4-1 Nome: ______________________________
Instrumento: __________________________
4-2 Nome: _______________________________
Instrumento: __________________________
4-3 Nome: _______________________________
Instrumento: __________________________
4-4 Nome: _______________________________
Instrumento: __________________________
5.Resumo currículo do candidato:
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6.Tomou conhecimento do prêmio através de:
( ) Site ( ) Jornais ( ) Rádio
( ) Cartaz ( ) Televisão
Outros: Qual: