Biennial of Chaco - First On Line International Contest of Sculpture - Application Form

<body bgcolor="white" text="black"> <div align="left"> <table border="0" cellpadding="0" cellspacing="10" width="100%"> <tr> <td colspan="2"><img src="../imagenes/ingl/BARRAp4.gif" border="0" usemap="#navbar1" width="640" height="58"><map name="navbar1"><area href="04.html" coords="189,36,265,55" shape="rect" alt="Reglamento"><area href="08.html" coords="515,35,612,56" shape="rect" alt="Envio de Proyectos"><area href="06.html" coords="350,36,416,57" shape="rect" alt="El Jurado"><area href="05.html" coords="269,35,349,55" shape="rect" alt="Los Premios"></map></td> </tr> <tr> <td valign="top" width="139"> <table border="0" cellpadding="0" cellspacing="0" width="139"> <tr> <td rowspan="6"><img height="378" width="30" src="../imagenes/DIRfija.jpg"></td> <td><a href="mailto:urunday@bienaldelchaco.com"><img height="25" width="107" src="../imagenes/ingl/contacte.jpg" border="0" alt="Contacto"></a></td> </tr> <tr> <td><a href="../spanish/03.html"><img height="55" width="107" src="../imagenes/ingl/COLp.jpg" border="0" alt="Concurso On Line"></a></td> </tr> <tr> <td><a href="../spanish/10.html"><img height="100" width="107" src="../imagenes/ingl/BIEa.jpg" border="0" alt="Bienal 2002"></a></td> </tr> <tr> <td><a href="../spanish/20.html"><img height="43" width="107" src="../imagenes/ingl/FUa.jpg" border="0" alt="Fundacion Urunday"></a></td> </tr> <tr> <td><a href="../spanish/30.html"><img height="100" width="107" src="../imagenes/ingl/CONa.jpg" border="0" alt="Concursos"></a></td> </tr> <tr> <td><a href="../spanish/40.html"><img height="55" width="107" src="../imagenes/ingl/RESa.jpg" border="0" alt="Resistencia"></a></td> </tr> </table> </td> <td valign="bottom" width="400"> <div align="left"> <form name="Inscripcion" action="../cgi-bin/soupermail.cgi" method="post" enctype="multipart/form-data"> <input type="hidden" value="../cgi-bin/forms/config.txt" name="SoupermailConf"> <table border="0" cellpadding="10" cellspacing="0"> <tr> <td valign="bottom"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="6"><b>APPLICANT FORM</b></font> <p><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b><input type="hidden" value="DATOS PERSONALES" name="Datos Personales" disabled>Applicant Kind:<br> </b><input type="radio" value="Individual" name="Tipo_de_Inscripcion" checked tabindex="1">Individualy <input type="radio" value="Equipo" name="Tipo_de_Inscripcion" tabindex="2">Team (Up to 4 integrants) </font></td> <td align="center" valign="middle"> <div align="left"> <img height="116" width="143" src="../imagenes/marcaCOL.jpg" border="0"></div> </td> </tr> <tr> <td valign="bottom"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b>Personal Data: </b>(Induvidual/ 1st Applicant)<b><br> </b>Name:<br> <input type="text" name="Nombre1" size="24" accesskey="1" tabindex="3"><br> Last Name:<br> <input type="text" name="Apellido1" size="24" accesskey="1" tabindex="4"><br> Type and No. of Identity Document:<br> <input type="text" name="Documento1" size="18" accesskey="1" tabindex="5"><br> Nationality:<br> <input type="text" name="PaisOrigen1" size="26" accesskey="1" tabindex="6"></font></td> <td><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b>Personal Data: </b>(2nd Applicant)<b><br> </b>Name:<br> <input type="text" name="Nombre2" size="24" accesskey="1" tabindex="7"><br> Last Name:<br> <input type="text" name="Apellido2" size="24" accesskey="1" tabindex="8"><br> Type and No. of Identity Document:<br> <input type="text" name="Documento2" size="18" accesskey="1" tabindex="9"><br> Nationality:<br> <input type="text" name="PaisOrigen2" size="26" accesskey="1" tabindex="10"></font></td> </tr> <tr> <td valign="bottom"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b>Personal Data: </b>(3rd Applicant)<b><br> </b>Name:<br> <input type="text" name="Nombre3" size="24" accesskey="1" tabindex="11"><br> Last Name:<br> <input type="text" name="Apellido3" size="24" accesskey="1" tabindex="12"><br> Type and No. of Identity Document:<br> <input type="text" name="Documento3" size="18" accesskey="1" tabindex="13"><br> Nationality:<br> <input type="text" name="PaisOrigen3" size="26" accesskey="1" tabindex="14"></font></td> <td><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b>Personal Data: </b>(4th Applicant)<b><br> </b>Name:<br> <input type="text" name="Nombre4" size="24" accesskey="1" tabindex="15"><br> Last Name:<br> <input type="text" name="Apellido4" size="24" accesskey="1" tabindex="16"><br> Type and No. of Identity Document:<br> <input type="text" name="Documento4" size="18" accesskey="1" tabindex="17"><br> Nationality:<br> <input type="text" name="PaisOrigen4" size="26" accesskey="1" tabindex="18"></font></td> </tr> <tr> <td valign="top"></td> <td align="center" valign="top"> <div align="left"> <font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b><input type="hidden" value="CONTACTO......" name="Contacto" disabled>Contact:</b><br> Country of Residence:<br> <input type="text" name="PaisResidencia" size="20" tabindex="19"><br> Province/State:<br> <input type="text" name="Provincia" size="25" tabindex="20"><br> Address:<br> <input type="text" name="Direccion" size="30" tabindex="21"><br> Zip Code:<br> <input type="text" name="Codigo_Postal" size="15" tabindex="22"><br> TeIephone/Fax:<br> <input type="text" name="Tel_Fax" size="29" tabindex="23"><br> E-mail:<br> <input type="text" name="Email" size="25" tabindex="24"><br> Web:<br> <input type="text" value="http://" name="website" size="35" tabindex="25"></font></div> </td> </tr> <tr> <td colspan="2" valign="bottom"><input type="hidden" value="CATEGORIAS......................" name="Categorias" disabled> <hr noshade size="1"> </td> </tr> <tr> <td valign="bottom"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b>Categories:</b></font><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b><br> </b></font><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><input type="radio" value="Profesional" name="Categoria" checked tabindex="26">Professional Sculptors<br> <img height="5" width="15" src="../imagenes/separa.gif" border="0">(Attach your CV [.txt or .rtf])<br> <img height="5" width="15" src="../imagenes/separa.gif" border="0"><input type="file" name="Curriculum" size="22"><br> <input type="radio" value="Vocacional" name="Categoria" tabindex="28">Emergent Vocations</font></td> <td align="center" valign="top"> <div align="left"> <font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b>Projects:</b></font><br> <font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><input type="radio" value="1" name="Cantidad_Proyectos" tabindex="29">1 or <input type="radio" value="2" name="Cantidad_Proyectos" tabindex="30">2</font></div> </td> </tr> <tr> <td colspan="2" valign="bottom"><input type="hidden" value="FORMA DE PAGO......." name="Forma de pago" disabled> <hr noshade size="1"> <font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b>Payment:</b><br> </font></td> </tr> <tr> <td valign="top"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><input type="radio" value="Deposito_Bancario" name="Pago" tabindex="31" checked><b>Deposit or Banking Transference</b><br> To Fundación Urunday, c/c Nro. 021-5477-07<br> Bank Boston N.A-H3500CIE Resistencia- Provincia del Chaco-Argentina.</font> <p><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2">Date of Deposit or Transfrence<br> <input type="text" name="Fecha_deposito_bancario" size="24" tabindex="36"><br> Bank<br> <input type="text" name="Banco_deposito_bancario" size="24" tabindex="37"><br> Warrant Number <img height="5" width="45" src="../imagenes/separa.gif" border="0">Type<br> <input type="text" name="ComproNro_deposito_bancario" size="15" tabindex="38"> - <input type="text" name="ComproTipo_deposito_bancario" size="10" tabindex="39"></font></td> <td valign="top"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b><input type="radio" value="Giro_Internacional" name="Pago" tabindex="32">International Remittance</b><br> To Fundación Urunday</font> <p><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2">Date of Shipment<br> <input type="text" name="Fecha_Envio_giro_internacional" size="24" tabindex="40"><br> Company<br> <input type="text" name="Empresa_giro_internacional" size="24" tabindex="41"><br> Warrant Number <img height="5" width="45" src="../imagenes/separa.gif" border="0">Type<br> <input type="text" name="ComproNro_giro_internacional" size="15" tabindex="42"> - <input type="text" name="ComproTipo_giro_internacional" size="10" tabindex="43"></font></td> </tr> <tr> <td valign="top"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b><input type="radio" value="Wester_Union" name="Pago" tabindex="33"> Wester Union, financial service<br> </b>Date of Shipment<br> <input type="text" name="Fecha_Envio_wester_union" size="24" tabindex="44"><br> Place of Shipment<br> <input type="text" name="Lugar_Envio_wester_union" size="24" tabindex="45"><br> Warrant Number <img height="5" width="45" src="../imagenes/separa.gif" border="0">Type<br> <input type="text" name="ComproNro_wester_union" size="15" tabindex="46"> - <input type="text" name="ComproTipo_wester_union" size="10" value=" " tabindex="47"></font></td> <td valign="top"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><input type="radio" value="Cheque" name="Pago" tabindex="34"><b>Cheque <i>(valid only for Argentina)</i></b><br> Enviar por correo cheque bancario cruzado, a la orden de Fundación Urunday.<br> <br> Cheque Nro.<br> <input type="text" name="Numero_cheque" size="24" tabindex="48"><br> Banco<br> <input type="text" name="Banco_cheque" size="28" tabindex="49"><br> <br> <b>Envio</b><br> Fecha de Envio<br> <input type="text" name="Fecha_Envio_cheque" size="28" tabindex="50"><br> Empresa<br> <input type="text" name="Empresa_Envio_cheque" size="28" tabindex="51"><br> Comprobante Número <img height="5" width="15" src="../imagenes/separa.gif" border="0">Tipo<br> <input type="text" name="ComproNro_cheque" size="15" tabindex="52"> - <input type="text" name="ComproTipo_cheque" size="10" tabindex="53"></font></td> </tr> <tr> <td colspan="2" valign="top"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b><input type="radio" value="Personalmente" name="Pago" tabindex="35">Directly in ours office</b><br> Av. San Martín 475 (3500) Resistencia, Chaco, Argentina</font></td> </tr> <tr> <td colspan="2" valign="bottom"> <center> <font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b><input type="submit" value="Send" name="Inscripcion" tabindex="54"> <input type="reset" value="Reset" tabindex="55"><br> </b></font></center> </td> </tr> <tr> <td colspan="2" valign="bottom"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b>If you want to accomplish the payment by some way not including in the previous options, do not doubt in contacting to us.</b></font> <p><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular" size="2"><b>FUNDACION URUNDAY</b><br> Av. San Martín 475 (3500) Resistencia, Chaco, Argentina.<br> Tel/ Fax : 54 3722 436694<br> e-maiI: <a href="mailto:urunday@bienaldelchaco.com">urunday@bienaldelchaco.com</a></font></td> </tr> </table> </form> </div> </td> </tr> </table> </div> </body>