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Form A) “DIGITAL DIARY OF BASILICATA – SECOND EDITION” APPLICATION FORM TO PARTICIPATE IN THE SELECTION FOR THE DESIGN, PRODUCTION AND PUBLICATION OF VIDEO STORIES REGARDING THE BASILICATA REGIONI, _________________________________________________born in (town)___________________on (date)_____________________domicilein _______________________________________________town______________________________________________zip code __________________________________country____________________________________________e-mail _____________________________________________phone (landline) ______________________phone (mobile) ______________________would like to take part in the selection process for the projectregarding production andpublication / posting of video stories on theBasilicata Region organized by the Agency fortheTerritorial Promotion of the Basilicata Region(Agenzia di Promozione Territoriale -APT),with public noticepublished on the 29th June, 2012with a video referring to one of thefollowing topics:L’aglianico: an interpreter of Lucanian territory;The Sassi di Matera: 3D narration;The lookof love: storiesof loveand "complicity" of the Lucanian landscape;Stories of emigration and returns: the imaginative world of memory and the landscape of the land“recovered”;Basilicata, nice discovery: the eyesof women;Genuineness and beauty: the strength of tradition; 1 “DIGITAL DIARY OF BASILICATA – SECOND EDITION” APPLICATION FORM

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For this purpose I hereby declare that:a. My level of spoken and written English is: sufficient, fluent,excellent, mother tongue__________________________________________b. The equipment that I plan to use for the project is (manual and/or digital camera, video camera,audio system, pc, Mac, other,please specify)____________________________________________c. Describe your editing skills based on previous work that you havedone.____________________________________________d. Which programmes / software are you planning to use for thecreation of your video stories?____________________________________________e. Which programmes / software will you be using for you photos?____________________________________________f. Describe and illustrate the multimedia work you consider mostrepresentative your style of visualcreativity.Please specify techniques used, date and location of filming,purpose (technique used, time andplace of realization, which circumstance for ex. collective, personal, commissioned by a thirdparty).________________________________________g. Specify where and when it was released / diffused (on line,exhibition, other, if on line specifythe web site / url).___________________________________________h. How many unique visitors viewed your video? Please specifywhere it was published on and offline. Did it receive attentionfrom the press or any other form of review? Specify in detail url /website, magazine, other where reviewed.____________________________________________ 2 “DIGITAL DIARY OF BASILICATA – SECOND EDITION” APPLICATION FORM

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i. Which social networks are you a member of? How long have youbeen a member and how manyusers / friends for each do youhave? (ex. Facebook, Twitter, Flickr, Linkedln, Google Buzz, Orkut,deviantART, Myspace, Vimeo, Youtube, Badoo, Netlog, Friendster,Bebo, LiveJournal, Ning, Hi5,StumbleUpon, please specify anyothers)____________________________________________l. Describe your own blog / web site / page. Please specify type ofcontent, frequency with which itis updated and number offollowers.____________________________________________m. Describe any blogs / web sites / pages / forums etc. where youare a member, write orcontribute regularly.____________________________________________n.Briefly explain why you would like to particpate in the project.____________________________________________Candidates for topic no. D (Stories of emigration and returns: the imaginative world of memory and thelandscape of the land “recovered) have to add these information:a. to bea descendent ofparents/ grandparents/great grandparentsbornin Basilicata (specify the place ofbirth)._____________________________________________b. through the storyof my..... I get this idea of Basilicata :_____________________________________________ 3 “DIGITAL DIARY OF BASILICATA – SECOND EDITION” APPLICATION FORM

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Signature-----------------------I, …………………………..fully accept all the terms and conditionsstipulated in the Public Notice forparticpating in the production andpublication of video stories regarding the Basilicata Region.Signature-----------------------Please attach valid identity document.Note.The form must be signed where necessary and scanned or converted to pdf. Applicants can participate in the selectionprocess by sendingForm A) to the following e-mail address:lotito@aptbasilicata.it, by 3/08/2012 (August3, 2012) 4 “DIGITAL DIARY OF BASILICATA – SECOND EDITION” APPLICATION FORM