The Application Form

The Application Form                           Place for your  Photo

                                                                                                       

 

I kindly request that you consider the question of my joining the Regional Community Organization «Moscow Artistic League «Metropolis». I agree with the rules of the organization.

Surname

Name

Creative alias (pseudonym)

Birthdate (date, month, year)

Birthplace

Citizenship

Passport number

Place of issuing of your passport

Mobile phone number

Home telephone number

Office telephone number

        E-mail:                                         

        http:// www.  

Postal address (including the postcode)

Country

Region, state, city

Street, house number, flat number

 

The date of joining 

 The date of filling the form

Your signature

The signature of the head of the organization

The membership identity card number

 

Additional information

In what sphere of Art do you work?

1.

2.

Short summary of your creative work (main creative projects in chronological order)

1.

2.

3.

4.

5.

Your education, qualification (if you have several diplomas and qualifications, mention all of them)

1.

2.

3.

Awards, honorary degrees

1.

2.

3.

Place of work, position

1.

2.

In what spheres of the League activities you think you can be useful?

Can you take an active part in the work of the organization?

Yes.                 No.               Not always.