Aktualności
O konkursie
Regulamin
Nagrody
Partnerzy
PL
EN
Formularz rejestracyjny / Registration form
Pola oznaczone
*
są wymagane / Fields marked with asterisk
*
are required
Imię / First name
*
Nazwisko / Surname
*
Data urodzenia - rok / Date of birth - Year
*
Rok / Year
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Data urodzenia - miesiąc / Date of birth - Month
*
Miesiąc / Month
1
2
3
4
5
6
7
8
9
10
11
12
Data urodzenia - dzień / Date of birth - Day
*
Dzień / Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Adres - kod i miasto / Address: City / Town and postal code
*
Adres - ulica i nr domu / Address: Street and house number
*
Kraj zamieszkania / Country of residence
*
Wybierz kraj / Select country
--------------------
United States
Canada
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (DR)
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (North)
Korea (South)
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and South Sandwich Islands
Spain
Sri Lanka
Sudan
South Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Telefon / Phone number
*
prefix i numer / Country and area code, prefix and phone number
E-mail
*
WWW
Biografia/CV - pliki typu: doc, docx, rtf, pdf / Biography/CV - accepted file types: doc, docx, rtf, pdf
*
Fallback
Fotografie format jpg do 3MB / Photos jpg format max. 3MB
*
Fallback
Nagrania mp3 - do 15MB / Recordings in mp3 format max. 15MB
*
Fallback
Regulamin / Regulations
*
Zapoznałam/em się i akceptuję
regulamin konkursu
/ I have read and accepted the
regulations
Wyrażam zgodę na przetwarzanie moich danych osobowych w celach organizacji i przeprowadzenia konkursu oraz udostępnienia informacji o wynikach konkursu. Przyjmuję do wiadomości, iż administratorem danych osobowych jest Fundacja im. Zbigniewa Seiferta z siedzibą przy ul. Chrzanowskiego 13/21, Warszawa. Posiadam wiedzę, że podanie danych jest dobrowolne, jednak konieczne do realizacji celów, w jakim zostały zebrane.
I hereby give consent for my personal data to be processed for the purposes of conducting the Competition and making the information concerning the Competition results publicly available. I acknowledge that I understand and accept that the Zbigniew Seifert Foundation, with seat at 13/21 Chrzanowskiego Street, 04-392 Warsaw, is the administrator of my personal data. I am aware that making my data available is not obligatory, but is necessary for the purpose for which these data have been collected.
Wyślij / Send