Page 204 - El Libro Official

EN 01-01-2019 page A

ESFIAP - HonEFIAP

A DOSSIER FOR FIAP DISTINCTION

ADMINISTRATIVE DOSSIER

Distinction requested: Year: Country:

Federation:
Date:

UN Code:

Name and signature of the person responsible within the federation

By his signature the person responsible within the federation

confirms that the data given have been verified.

CANDIDATE

Complete name Male:

automatic do not fill in >> Female:

Surname: Given name(s):

Nationality: Date of birth (day/month/year):

Adress:

Postal code + city:

E-mail:

Number of the FIAP Photographer's Card: Number FP (Profile Number) :

Send the complet document (pages A , B and C) by email to fiapdistinctions@gmail.com

Send the pages A and B on paper by postal mail to Chris Discart - Hagenbroeksesteenweg 174 - B 2500 Lier - Belgium