Cân i Gymru 2015 competition entry form

Name:………………………………………………………………………...

Address: ……………………………………………………………………..

Telephone number (home) : …………………………………………………

Telephone number (mobile): ………………………………………………..

E-mail address: ……………………………………………………………….

Date of birth: …………………………………………………………………..

Name of song: …………………………………………………………………

Author of lyrics:……………………………………………………………......

Composer: ……………………………………………………………………..

Suggest the artist/s you would like to perform the song: ……………………

Please read the competition rules before proceeding. For a copy of the rules, go to : s4c.co.uk/canigymru

Or call 02920 838 149 to order a copy by post (24hr answerphone).

Please tick the box to confirm that you have read, understood and agree to the

terms of the competition rules.

Cassette or CD or MP3 Copy of the lyrics on paper or in word format

Send your entry form and song by 16 January 2015

By post to: Cân i Gymru 2015,Avanti Media, 36 Cardiff Road, Llandaf, Cardiff, CF5 2DR

By e-mail to: cais@ avantimedia.tv

Competition number (for office use only)