UNIUNEA ARTISTILOR PLASTICI DATA PRIMIRII: _____________

DIN ROMÂNIA COD ARTIST: ________________

FISA PERSONALA

Numele si prenumele: __________________________________________________

Numele purtat anterior: _________________________________________________
Nascut: ziua:_____, luna:_____, anul: ___________, în localitatea: ______________
Domiciliul actual: orasul ______________________, sector (judet) ______________
strada: _____________________________________, nr. ____, bloc:_____, sc. ____,
ap._______, telefon: _____/______________, mobil: _________________________
adresa e-mail ___________________________________________________
posesor B.I. (C.I.): seria: ______, nr.: _____________, C.N.P.: _________________
eliberat de __________________.
Cetatenia _______________________, nationalitatea _________________________,
limbi straine cunoscute _________________________________________________
Studii: liceul: _________________________________________________________
Studii de specialitate: ___________________________________________________
Anul absolvirii: _____________, specialitatea _______________________________
Adresa atelier:_________________________________________________________

Specialitatea pentru care solicita primirea în Uniunea Artistilor Plastici din România
– Filiala ________________________.

Sunt de acord cu prelucrarea datelor cu caracter personal_______________________

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 ACTIVITATEA ARTISTICA

I. Participari la expozitii de grup sau colective în tara si

strainatate:
Data expozitiei Denumirea si locul expozitiei
1. __________________________________________________________

2. __________________________________________________________

3. __________________________________________________________

4. __________________________________________________________

5. __________________________________________________________

6. __________________________________________________________

7. __________________________________________________________

8. __________________________________________________________

9. __________________________________________________________

10. __________________________________________________________

11. __________________________________________________________

12. __________________________________________________________

13. __________________________________________________________

14. __________________________________________________________

15. __________________________________________________________

II. Expozitii personale în tara si strainatate:

Data expozitiei Denumirea si locul expozitiei
1. __________________________________________________________

2. __________________________________________________________

3. __________________________________________________________

4. __________________________________________________________

5. __________________________________________________________

6. __________________________________________________________

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 7. __________________________________________________________

8. __________________________________________________________

9. __________________________________________________________

10. __________________________________________________________

11. __________________________________________________________

12. __________________________________________________________

13. __________________________________________________________

14. __________________________________________________________

15. __________________________________________________________

16. __________________________________________________________

17. __________________________________________________________

18. __________________________________________________________

19. __________________________________________________________

20. __________________________________________________________

III. Tabere în tara si strainatate:

Data taberei Denumirea si locul taberei
1. __________________________________________________________

2. __________________________________________________________

3. __________________________________________________________

4. __________________________________________________________

5. __________________________________________________________

6. __________________________________________________________

7. __________________________________________________________

8. __________________________________________________________

9. __________________________________________________________

10. __________________________________________________________

11. __________________________________________________________

12. _____________________________________________________

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IV. Alte forme de activitate (conferinte, prelegeri, articole, etc):

1. __________________________________________________________

2. __________________________________________________________

3. __________________________________________________________

4. __________________________________________________________

5. __________________________________________________________

6. __________________________________________________________

7. __________________________________________________________

8. __________________________________________________________

9. __________________________________________________________

10. __________________________________________________________

V. Premii, distinctii, burse:

Anul acordarii Denumirea

1. __________________________________________________________

2. __________________________________________________________

3. __________________________________________________________

4. __________________________________________________________

5. __________________________________________________________

6. __________________________________________________________

7. __________________________________________________________

8. __________________________________________________________

9. __________________________________________________________

10. __________________________________________________________

Declar pe propria raspundere autenticitatea datelor.

Semnatura, Data,