SCHEDA DI ISCRIZIONE / ENTRY FORM
VIII EDIZIONE
POZZUOLI (NAPOLI) – ITALY
18 > 21 GIUGNO 2015
Regia / Director: ______________________________________________________________________________________________________________
Titolo originale / Original title: ______________________________________________________________________________________________
Titolo in inglese / English title: ______________________________________________________________________________________________
Sezione / Section:
Animazione 
Durata / Running time: ___________________
Documentario 
Fiction 
Sperimentale 
Anno di produzione / Year of production: 2013 2014 2015
Paese di produzione / Country of production: _____________________________________________________________________________
Lingua originale / Original language: _______________________________________________________________________________________
Sottotitoli / Subtitles: SI / YES NO
Lingua dei sottotitoli / Language of subtitles: _____________________________
Interpreti / Leading actors: __________________________________________________________________________________________________
Sceneggiatura / Screenplay: _________________________________________________________________________________________________
Fotografia / Photography: ______________________________________ Montaggio / Editor: _____________________________________
Suono / Sound: _____________________________________________ Musica / Music: _______________________________________________
Produttore / Producer: ______________________________________________________________________________________________________
Formato di ripresa / Shooting format: Mini DV 16 mm 35 mm HD Altro / Other ___________________________________
Formato film / Aspect ratio: 16:9 4:3 2.35:1 Altro / Other ____________________________________________________________
Sinossi / Synopsis : ___________________________________________________________________________________________________________
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Biofilmografia dell’autrice / Personal and professional record of the director: ________________________________________
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“A Corto di Donne” – c/o Azienda Autonoma Cura, Soggiorno e Turismo
Piazza Matteotti, 1 – 80078 Pozzuoli (NA) – Italy
www.acortodidonne.it – e-mail: [email protected] – tel. (+39) 347.6675.785
DATI PERSONALI REGISTA / PERSONAL DATA OF THE DIRECTOR
(in caso di due o più registe, aggiungere un allegato con i dati richiesti / in case of two or more directors, please
add a new sheet with the information required)
Cognome / Family name ________________________________________ Nome / First name ______________________________________
Luogo di nascita / Place of birth ____________________________________________________________________________________________
Stato / Country ____________________________________________ Anno di nascita / Year of birth _______________________________
Indirizzo / Address ___________________________________________________________________________________________________________
Città / City _______________________________ CAP / Zip Code _____________________ Stato / Country __________________________
Tel. ___________________________________________________ Cell. / Mobile phone _________________________________________________
E-mail (in maiuscolo / in capital letters) ___________________________________________________________________________________
Website ________________________________________________________________________________________________________________________
PRODUZIONE – DISTRIBUZIONE – AGENZIA / PRODUCTION COMPANY – DISTRIBUTION – AGENCY
(da compilare se diverso dalla regista / to be filled only if different from the director)
Nome della società / Company name _______________________________________________________________________________________
Nome del contatto / Contact’s name ________________________________________________________________________________________
Indirizzo / Address ___________________________________________________________________________________________________________
Città / City _______________________________ CAP / Zip Code _____________________ Stato / Country __________________________
Tel. ____________________________________________________ Cell. / Mobile phone ________________________________________________
E-mail _________________________________________________________ Website _____________________________________________________
I contatti per questo cortometraggio saranno tenuti da / Contacts for this film will be held by:
Regista / Director 
Produzione - Distribuzione - Agenzia / Production Company - Distribution - Agency 
L’eventuale materiale informativo extra – pressbook, fotografie, lista dialoghi ecc. – potrà essere inviato, in caso
di selezione del cortometraggio, tramite e-mail all’indirizzo [email protected] / Docs, stills and dialogue lists
can be sent by e-mail, if the short film is selected, to the address [email protected].
La partecipazione alla selezione della rassegna, attraverso la compilazione di questa scheda, sottintende la piena
accettazione del suo regolamento. I dati personali forniti saranno trattati in conformità con quanto stabilito dal
D.L. 196/2003 sulla privacy e successive modifiche / Participating in the competition implies acceptance of the
Regulations. Personal data will be treated according to the legislative decree of the Italian Law N° 196 of
30.06.2003 about privacy and subsequent modifications.
Luogo e data / Place and date ____________________________________
Firma / Signature
____________________________________
“A Corto di Donne” – c/o Azienda Autonoma Cura, Soggiorno e Turismo
Piazza Matteotti, 1 – 80078 Pozzuoli (NA) – Italy
www.acortodidonne.it – e-mail: [email protected] – tel. (+39) 347.6675.785