Surname ................................................................................................

Name .....................................................................................................

Place and date of birth ..........................................................................
...............................................................................................................

Nationality ..............................................................................................

Permanent address and telephone
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................

e-mail ....................................................................................................

Temporary address and telephone
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................

I will bring along my accompanist Yes No

Accompanist’s name………………………………………….

I agree to abide by the rules of the Grand Prix and to accept the decision of the jury.

Signature…………………………………………………………………….

Date…………………………………………………………………………..

Note: Please type or use capital letters when filling in the forsm