DATA PRIMIRII: _____________

COD ARTIST: ________________

FIȘA PERSONALĂ

Numele și prenumele: __________________________________________________

Numele purtat anterior: _________________________________________________

Născut: ziua:_____, luna:_____, anul: ___________, în localitatea: ______________

Domiciliul actual: orașul ______________________, sector (județ) ______________

strada: _____________________________________, nr. ____, bloc:_____, sc. ____,

ap._______, telefon: _____/______________, mobil: _________________________

adresă e-mail _________________________________________________________

posesor B.I. /(C.I.): seria: ______, nr.: _____________, C.N.P.: _________________

eliberat de ___________________________________________________________.

Cetățenia _______________________, naționalitatea _________________________,

Studii: liceul: _________________________________________________________

Studii de specialitate: ___________________________________________________

Anul absolvirii: _____________, specialitatea _______________________________

Specialitatea pentru care solicită primirea ca membru stagiar în Uniunea Artiștilor

Plastici din România_______________Filiala_______________________________.

Sunt de acord cu prelucrarea datelor cu caracter personal_______________________

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 ACTIVITATE ARTISTICĂ

I. Participări la expozitii de grup sau colective în tara și

străinătate:
Data expoziției Denumirea și locul expoziției
1. __________________________________________________________
2. __________________________________________________________
3. __________________________________________________________
4. __________________________________________________________
5. __________________________________________________________
6. __________________________________________________________
7. __________________________________________________________
8. __________________________________________________________
9. __________________________________________________________
10.__________________________________________________________
11.__________________________________________________________
12.__________________________________________________________
13.__________________________________________________________
14.__________________________________________________________
15.__________________________________________________________

II. Expoziții personale în țară și străinătate:

Data expoziției Denumirea și locul expoziției
1. __________________________________________________________
2. __________________________________________________________
3. __________________________________________________________
4. __________________________________________________________
5. __________________________________________________________
6. __________________________________________________________

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 7. __________________________________________________________
8. __________________________________________________________
9. __________________________________________________________
10.__________________________________________________________
11.__________________________________________________________
12.__________________________________________________________
13.__________________________________________________________
14.__________________________________________________________
15.__________________________________________________________

III. Tabere în țară și străinătate:

Data taberei Denumirea și locul taberei
1. __________________________________________________________
2. __________________________________________________________
3. __________________________________________________________
4. __________________________________________________________
5. __________________________________________________________
6. __________________________________________________________
7. __________________________________________________________
8. __________________________________________________________
9. __________________________________________________________
10.__________________________________________________________
11.__________________________________________________________
12.__________________________________________________________
12.__________________________________________________________
13.__________________________________________________________
14.__________________________________________________________
15.__________________________________________________________

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IV. Alte forme de activitate (conferințe, prelegeri, articole, etc):
1. __________________________________________________________
2. __________________________________________________________
3. __________________________________________________________
4. __________________________________________________________
5. __________________________________________________________
6. __________________________________________________________
7. __________________________________________________________
8. __________________________________________________________
9. __________________________________________________________
10.__________________________________________________________

V. Premii, distincții, burse:

Anul acordării Denumirea
1. __________________________________________________________
2. __________________________________________________________
3. __________________________________________________________
4. __________________________________________________________
5. __________________________________________________________
6. __________________________________________________________
7. __________________________________________________________
8. __________________________________________________________
9. __________________________________________________________
10. __________________________________________________________

Declar pe propria răspundere autenticitatea datelor.

Semnătura, Data,