Student Form
Please fill in with capital letters or on the computer.
- Emblem: Earl
- Author’s Name and Surname: JAN KOWALSKI
- Author’s Address: 20-079 LUBLIN, UL. CICHA4
- E-mail Address: JANKOWALSKI@GMAIL.PL
- Phone Number: 5025356
- Medical university: MEDICAL UNIVERSITY IN LUBLIN
- Faculty: MEDICAL
- Titles of the submitted photographs (mark if the photograph is a part of a series):
1. FOREST
2. MANSION
3. MS BARBARA
4. WARSZAWAI –PHOTO NO 1 OF THE CITY PHOTO SERIES
5. WARSZAWAII – PHOTO NO 2 OF THE CITY PHOTO SERIES
6. KRAKÓW – PHOTO NO 3 OF THE CITY PHOTO SERIES
NOTICE!
WE HEREBY REMIND YOU THAT – Each contestant may send the maximum number of 6 photographs, including 1 photo series consisting of the maximum of 3 photographs. Photographs may be entered in any number of contest categories.
Contestant is not required to submit a photo series, it is possible to enter 6 individual photographs in one contest category.
I hereby state that that the photographs submitted to the contest have been taken personally and that I am the sole proprietor of the copyrights to the works, as well as that the works do not infringe third party or material rights and that I possess the consent of the portrayed persons for the publication of their images.
I hereby grant the right to use the photographs free of charge in the contest promotional materials and their publication on the organizer’s website.
I hereby give my consent for my personal data to be processed by LubelskaIzbaLekarska with its registered seat in Lublin at ul. Chmielnej 4, in accordance with the Personal Data Protection Act dated 29th August 1997 (Journal of Laws No 133, item 883) for the purpose of 5th National Photo Contest for Doctors and Medical Students.
Date and Signature ……………………………
