APPLICATION FORM FOR STANISLAV LIBENSKÝ AWARD 2018
ABOUT YOU
Name and surname
*
Date of birth
(DD/MM/YYYY)
*
Nationality
*
Street and number
*
City
*
Postal code
*
Country
*
Phone number
*
E-mail
*
Website of the applicant (if applicable)
ABOUT SCHOOL & WORK
Name of the university/school
*
Specialization/Department
*
Leading teacher
*
Title of the work
*
Technique
*
Material
*
Year of realisation
*
Size
(length x width x height [cm])
*
Last academic year 2018
My applied work is my final work
Selling price in CZK currency
My work is available for the period (
20.9. - 19.11.2018
)
*
Yes
No
Annotation - description of the object (
max 120 words
)
*
Specific installation instructions (if applicable)
ATTACHED DATA
Please add only photos in printable quality (300 DPI, JPG format max 6 MB!)
Photo of the applicant
*
1. photo of the work
*
(IF APPLICABLE) 2. photo of the work
(IF APPLICABLE) 3. photo of the work
I fully understand and agree with the
terms and conditions
of Stanislav Libenský Award 2018. I also agree with evidence of my personal data for purpose of the Competition.
SUBMIT
