Open Mic Reg

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OPEN MIC NIGHT

Please complete this form and return it to Kulcha Shift, 210 Timor Street, Warrnambool

Competition Details
Date: Wednesday, 10st July, 2013 Time: 6pm8:00pm

Entrants Details
Name of act: How would you best describe your style of performance? What instruments will your performance be using tonight? ________ Hometown: Contact Person: Age of performers: Where did you hear about this event? PH:______

All performers are required to bring their own instruments and instrument leads. Mics, Mic stands, DIs, PA and stage will be supplied. We look forward to listening to your performance

DECLARATION
I, the undersigned, acknowledge that, while Ignite youth and Brophy Family and Youth Services will take all due care, they are to be free of all responsibility arising from any accident or illness incurred by participants during this competition.
Entrant signed: Date: / /

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