FULL DE PARTICIPACIÓ DE CENTRE 40è Premi Enric Farreny 12è Premi Sambori Òmnium 2018 DADES DEL CENTRE NOM: ADREÇA: POBLACIÓ I CODI POSTAL: TELÈFON/S: ADREÇA ELECTRÒNICA: PERSONA DE CONTACTE: NOMBRE TOTAL d’alumnes del centre que han participat: NOMBRE TOTAL de treball seleccionats per representar el centre: SEU TERRITORIAL: Terres de Ponent CATEGORIA:

DADES DE L’AUTOR O AUTORA NOM I COGNOMS: TÍTOL REDACCIÓ:

Curs: No autoritzo Òmnium Cultural a cedir les meves dades a entittas col·laborades. En compliment de la LOPD (Llei Orgànica de Protecció de Dades de Caràcter Personal 15/1999 de 13 de desembre i la Directiva Europea 2016/680 de 27 d’abril), ómnium Cultural us informa que les vostres dades serán incloses, o bé ja ho están, en un fitxer registrat a nom de l’entitat, amb la finalitat de poder-vos informar de les nostres activitats. Podeu exercir el dret d’accés, rectificació, oposición i cancel·lació de les vostres dades, adreçant-vos per escrit a [email protected], o bé a Òmnium Cultural, carrer Diùtació, 276, 08009 de Barclona.

Número de referència: A emplenar per l’organització

EF-Sambori, fitxa participació 2018 (1).pdf

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