NATIONAL APPLICATION FORM

PERSONAL DETAILS
*Gender:  
*First Name:  
*Last Name:  
*Address:  
*Suburb:  
*State:  
*Postcode:  
*Email:  
Telephone (mobile):  
*Telephone (home):  

*Date of Birth:

  

*Age at 25/4/2008:

  

*Instrument:

  
Nominated performance program for the Finals Concert, if selected:  
Details of education. (ie Degrees, diplomas, musical or other relevant qualifications, prizes won, awards or scholarships):
details:  
     
*Courses currently being undertaken:  
*CD recorded at:  
*Date:  
Referees
*Referee Name 1:  
*Referee Address 1:  
*Referee phone 1:  
     
Referee Name 2:  
Referee Address 2:  
Referee Phone 2:  

Previous Experience
Have you competed in the Geelong Advertiser Music Competition before?:  

*

  

ENTRANTS UNDER THE AGE OF 18

If you are under the age of 18 years on 25th April 2008, the following declaration must be completed by your Father, Mother, Guardian.


I _______________________________________________

Of_______________________________________________

am the of the entrant (above) who is

__________ years of age on 25th  April 2008.

I have read the conditions of entry as stated in the brochure and agree to the entry being made.

Signature

_______________________________________________

Date

_______________________________________________

 
 

APPLICANT’S DECLARATION

I wish to enter the Geelong Advertiser Music Competition, Costa National Prize. I have read the conditions of this competition as set out and agree to abide by them. I declare that I am an Australian citizen or a permanent resident of Australia who is currently domiciled in Australia. I understand that changes from my nominated performance will not be permitted except at the discretion of Geelong Advertiser Music Competition Trust.

I apply for the Geelong Advertiser National Music Competition, and agree to abide by the rules
of the Competition and accept the decision of the adjudicator. If selected as a finalist I consent to perform in public before an adjudicator and an audience at Costa Hall, Waterfront Campus, Deakin University on the evening of Saturday August XX, 2008.

I acknowledge that, should I receive an award, I will perform without fee at a concert in Geelong at a place and time to be advised.

I enclose my entry fee for these awards, a cheque/postal order for $25.
(Do not send cash in the mail.)

Signature

_______________________________________________

Date

_______________________________________________

 
 
 

CHECKLIST: Have you?

  • Read and Understood the terms of entry?
  • Completed all of the entry form in every detail?
  • Checked the Final Concert date and ensure your availability?
  
   

ENTRIES TO BE POSTED TO
Event Coordinator
Geelong Advertiser Music Competition
GPAC
PO BOX
Geelong VIC 3220

  
How did you hear about the Geelong Advertiser Music Competition?
*    
Please specify:  
* I accept the terms and conditions of entry  
 

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