Instituia Public Naional a Audiovizualului

Cerere de nregistrare
la Concursul de Preselecie pentru reprezentarea Republicii Moldova la Concursul Internaional Eurovision
Song Contest 2016, Stockholm, Suedia.
Bazai pe informaia primit (Anexa1), prin completarea prezentei Cereri, confirmm nregistrarea la
Concursul de Preselecie Eurovision Song Contest 2016 (Republica Moldova), suntem familiarizai cu
Regulamentul privind condiiile Concursului de Preselecie i suntem de acord cu stipulrile acestuia.
Titlul piesei:

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Interpret (nume, semntur):

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Compozitor (nume, semntur):

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Autor text (nume, semntur):

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Aranjament (nume, semntur):

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Data depunerii cererii

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Date biografice interpret:

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Date biografice, compozitor:

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Date biografice, autor text:

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Date biografice, aranjor:

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Telefon:__________________________________
Email:____________________________________

Contacte TRM:
MD2028, Chiinu, os. Hnceti 64
Tel.:/Fax: /+373/ 73 94 70
Email: eurovision@trm.md
www.trm.md