registration form international piano competition...
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International Piano Competition 2018 “From BACH to JAZZ” Entry Fees
Groups A and B: 60€ - Groups C and D: 80€ - Group E and F: 100€ Application Form 2018 (to be sent by e-mail)
(Entry before February 28th 2018)
(to be completed in capital letters)
GIVEN NAME .............................................. SURNAME ................................................................ DATE OF BIRTH ................................................... NATIONALITY ................................................. ADDRESS ........................................................................................................................................ POSTAL CODE ................... TOWN ...................................... COUNTRY ..................................... TEL ................................................... MOBILE PHONE .................................................................. E-MAIL ............................................................................
Teacher’s name and address .......................................................................................................
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Teacher’s Tel. and e-mail ................................................................................................................
CHOSEN GROUP ................................
CHOSEN PROGRAM ...............................................................................................................
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FROM WHICH SOURCE DID YOU LEARN ABOUT THE COMPETITION? ……..…………………. (Internet / teacher / friends / poster / other)
Attachments: 1) Bank transfer / Paypal receipt ................................................................................................
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Bank account: BRED, IBAN: FR76 1010 7003 1200 3260 21426 42, SWIFT: BREDFRPPXXX, 48, Grande rue Charles de Gaulle, 94360 BRY-SUR-MARNE, France beneficiary “Association Nathalie” Paypal : [email protected]
2) proof of date of birth for candidates aged 16 years or less. CV for candidates 17 years and above, with copy of passport or ID
3) photo
Final acceptance of entry only upon complete payment of the entry fees. I confirm having read the Rules and agree to abide by them.
Date ....................................................
……………………………………. Candidate’s signature (or of one parent/guardian for minors)
Address: Concours “De Bach au Jazz” Association Nathalie 33 rue du Commandant Mouchotte 75014 Paris - France [email protected]