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Nom de lartiste, troupe, compagnie ou groupe:
Adresse:
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Discipline prsente :
Le responsable (de la troupe, compagnie ou groupe)
- Nom:
- Coordonnes:
- Adresse mail:
Les membres de la troupe, compagnie ou groupe:
- NOMS PRENOMS FONCTIONS
- Autres contacts tlphoniques:
Prciser le nombre exact de personnes prvues sur le dplacement:
Prciser s'il s'agit dune cration, dune adaptation, dune reprise:
Nom de lauteur:
Nom du compositeur:
Prsenter en quelques lignes le spectacle (le thme ou l'histoire, le genre : traditionnel, contemporain etc.) :
Fiche technique : pour le matriel ncessaire la prsentation des uvres ou du spectacle:
Prciser le matriel personnel emporter (dtaill avec le volume et le poids):
Prciser le matriel demand sur place aux organisateurs, l'espace scnique ncessaire (fournir un plan de scne), les conditions techniques requises (clairages, rideaux, noir, rampes etc.) :
Notes et commentaires(partie rserve ladministration):
PAGE 3 / NUMPAGES 3
Direction de la Culture, 16 rue Gallieni 5e tage HYPERLINK "http://www.province-sud.nc/"www.province-sud.nc Ml: HYPERLINK "mailto:dc.contact@province-sud.nc"dc.contact@province-sud.nc PAGE 1 / NUMPAGES 3
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