ENTRY FORM 2012

Enter Online here

Make cheque payable to: The Kiwanis Music Festival of London Inc.
Print this Entry Form and mail with cheque or M.O. to P.O. Box 50008, London, ON N6A 6H8.
Entries must be received by Saturday, Dec. 3, 2011, 5:00 p.m.
COMPLETE ONE ENTRY FORM FOR EACH CLASS ENTERED and KEEP A COPY FOR YOUR RECORDS.
Festival Programs may be ordered at a cost of $5.00 each.

Class No.


 1st Name Last Name: School & Board

Class Name: (For Example - Female Vocal Solo - 12 yrs & U. - General OR Piano Solo - 16 yrs & U. - Romantic)

Address No:


Street:

City:

Postal Code:

Phone:


 Other:
 Birth Date:
 Age:
Your E-Mail Address  

Teacher: (check one) Private OR School
First Name:

Last Name:

Address:

Phone:

email:

Music Gr.

Number of Performers

Accompanist Name:

Own Choice Selections (Performance time in minutes required)

Title

Composer

Time (MINUTES)

1.

   

2.

   

3.

   

Duets, Trios, Quartets & Quintets (Please list performers in the space provided).

Surname

First Name

Instrument

Age

1.

     

2.

     

3.

     

4.

     

5.

     

 

 

Please List All Other Classes Entered To Help Us Avoid Conflicts

Class No. Class No. Class No.  
Class No. Class No. Class No.  
Class No. Class No. Class No.  

Class changes will not be permitted. It is the responsibility of the Competitor, Parent and Teacher to read ALL RULES and enter the correct class, by number.

I have read the Rules and Regulations. I certify that all conditions will be complied with in respect to this entry.

Competitor Signature:_________________________________

Parent Signature: ____________________________________

Teacher Signature:___________________________________

Reminder to all participants, parents and teachers that all suggestions, complaints or protests concerning the Festival must be directed in writing to "THE BOARD". 
Decisions of the adjudicators are final. 
--------------------------------------------------------------------------------------------------------
I give permission for my child _______________________________________,
and school to be included on the Kiwanis Music Fesival website
and performance program.
Parent's Signature/Guardian X...............................................................................................................................
 OR
I do NOT give permission for my child's name, ___________________________
to be included on the Kiwanis Music Fesival website and performance program.
Parents Signature/Guardian X........................................................................................................................
N.B. PRIVACY LEGISLATION REQUIRES A SIGNATURE. ________________________________________________________________
Tel. 519-432-5183
email: secretary@kiwanismusicfestivallondon.com

Entry Fee:

$

Program
------ @ $5.00:

$

Donation:

$

Total:
 $