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INTERNATIONAL ACADEMY OF MODERN ART

Secretariat of the Presidency – Rome (Aurelio) Giulio Sacchetti,10/B/16 Street – P.C. 00167
Tel. /FAX    0039.066373303 – 3806373303
E-Mail: accademia@aiam.it

ON. PRESIDENCY

I undersigned ……………………………………………………………………………………….born the………………………………………….

on (nation) ………………………………….city………………………………………………………………………………………………………….

domicilio……………………………………………………………………………………………………………………………………………………….

with the residence to ……………………………………………………………………………………………………………………………………..

Address…………………………………………………………………………………………………………………………..post code………………

telefono……………………………………………………………………………fax……………………………………………………………………….

Email……………………………………………………………….Internet……………………………………………………………………………….

provided of the following titles (1): …………………………………………………………………………………………………………………. …………………………………………………………………………………………………………………………………………………………………….

having participated to the following demonstrations (2) ……………………………………………………………………………………
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and having achieved the following recognitions (3) ……………………………………………………………………………………………
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with echoes of chronicle (4) ……………………………………………………………………………………………………………………………..
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He/She ASKS

of have counted in the Register on the «Corresponding Partners» of This Academy, to the Class

and to the Category (6) ………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………………………

Date ………………………………………………..

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(signature of the candidate)

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(signature of the partner presenter)

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(stamp and signature of the manager of the Gallery)

¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤¤
(1) point out cultural titles, academic, professional.
(2) personal shows, collective (point out place, epoch, Galleries).
(3) point out the gotten prizes and the signalings.
(4) point out critiques on newspapers, magazines or printed and the names of the critical writers.
(5) – cancel the clas not perinent: I Class = poetry -music -theater; II Class = painting -sculpture -architecture.
6) Indicated the category of belongings to choose between those indicated to the note 5