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Panevezys international ceramic symposium ’2016 application form

Please fill Application form *.doc>>

PANEVEZYS INTERNATIONAL CERAMIC SYMPOSIUM’2016
Outdoor Ceramic Sculpture
APPLICATION FORM

First name

Surname

Sex

Birth date

Passport No. / Country

Address

Telephone No.

Fax No.

E-mail

WEB

Resume (please attach)

Other related material (please attach)

Date

Signature

Send applications to:

Jolanta Lebednykiene, Director
Panevezys Civic Art Gallery
Respublikos 3
LT- 35199 Panevezys
LITHUANIA
Tel./Fax: (country: 370, city: 45) 584802
E-mail: galerija@arspanevezys.lt
www.arspanevezys.lt