DUBBO EISTEDDFOD ENTRY FORM 2015

PLEASE NOTE: A SEPARATE FORM IS TO BE USED FOR EACH DISCIPLINE

NO ENTRIES WILL BE ACCEPTED WITHOUT FULL PAYMENT
Additional entry forms can be photocopied or downloaded from
www.dubboeisteddfod.org.au

ENTRIES CLOSE FRIDAY 20TH MARCH 2015

Please indicate in the box which Discipline
this entry is for e.g.: Dance, Vocal, Instrumental, S & D
Please complete entry form and return (enclosing a stamped envelope if receipt is required) TO:
THE ENTRY SECRETARY, PO BOX 497, DUBBO NSW 2830,
Postmarked NO LATER than the closing date
Entry form must be accompanied by FULL ENTRY FEE, paid by CHEQUE/MONEY ORDER made payable to
City of Dubbo Eisteddfod Inc. OR DIRECT DEPOSIT to BSB: 932 000 ACC NO: 26026.
EFT receipt MUST be attached to entry form.
DECLARATION:
I have read all rules and conditions of the City of Dubbo Eisteddfod included in the Syllabus
I agree to adhere to all rules governing the City of Dubbo Eisteddfod
I have read and agree to comply with the rules of copyright as set out in the 2015 Syllabus
I will accept the advice and decisions of the committee on all questions or disputes.
I will provide all necessary photocopies to the Registration Clerk prior to competing
As a condition of entry I agree to competitors name being published in the Program
I give permission for my child to be photographed/videoed either as an individual or in a group by the official
photographer during the 2015 City of Dubbo Eisteddfod YES/NO
Signed by or on behalf of the competitor: _____________________________________Date: ______________________
(Must be signed by a person 18 years or over)
Print Name: ________________________________________________________________________________________
COMPETITOR NAME: _________________________________________________________________________________
TELEPHONE: HOME: ____________________________MOBILE: ______________________________________________
ADDRESS: __________________________________________________________________________________________
__________________________________________________________________________________________________
TEACHER/DANCE STUDIO: ___________________________________COPYRIGHT NO: ____________________________
Please add me to the email list to receive notification of the availability of the 2016 syllabus
Please add me to the mailing list to receive a copy of the 2016 Syllabus
MY EMAIL ADDRESS IS:

2015 SOLO ENTRY ONLY

CLASS
NUMBER

CLASS
DESCRIPTION

NAME OF COMPETITOR SOLO

ONLY
PLEASE PRINT CLEARLY

DATE OF
BIRTH

AGE AS AT
31/12/15

ENTRY FEE

SUB TOTAL $
THREE SEPARATE PROGRAMS WILL BE PRINTED
Vocal/Instrumental
Dance
Speech & Drama

Office Use
Only

No ordered @ $4.00 each

No ordered @ $4.00 each
No ordered @ $4.00 each
SUB TOTAL PAGE 1

$
$
$
$

SUB TOTAL PAGE 2 $

SUB TOTAL PAGE 3 $
TOTAL $
Entry form must be accompanied by FULL ENTRY FEE paid by CHEQUE/MONEY ORDER made payable to
City of Dubbo Eisteddfod Inc. OR DIRECT DEPOSIT to BSB: 932 000 ACC NO: 26026.
Attach EFT receipt with entry form.

Office Use Only

Entry No: _______

Payment Received: __________________________________________________

Notes: ______________________________________________________________________________________

2015 DUOLOGUES, DUOS, DUETS and TRIOS

PLEASE SUBMIT ONE ENTRY FORM PER DISCIPLINE ENTERED.
CLASS
NO

CLASS
DESCRIPTION

NAME
PLEASE PRINT CLEARLY

DATE OF
BIRTH

NAME
PLEASE PRINT CLEARLY

DATE OF
BIRTH

ENTRY
FEE

SUB TOTAL $
PLEASE ADD THE TOTAL OF THIS SECTION TO THE FRONT OF THE ENTRY FORM.

2015 GROUPS
CLASS
NO

CLASS
DESCRIPTION

GROUP NAME (20 characters or less)

PLEASE PRINT CLEARLY
How it is to be printed in Program

NO. IN GROUP
(Schools only)

ENTRY
FEE

SUBTOTAL $
PLEASE ADD THE TOTAL OF THIS SECTION TO THE FRONT OF THE ENTRY FORM.
Entry form must be accompanied by FULL ENTRY FEE paid by CHEQUE/MONEY ORDER made payable to
City of Dubbo Eisteddfod Inc. OR DIRECT DEPOSIT to BSB: 932 000 ACC NO: 26026. Attach EFT receipt with entry form.

2015 DANCE TROUPES

CLASS DESCRIPTION
CLASS
NO
9061
9062
9063
9090
9160
9161
9162
9163
9190
9290
9361
9362
9363
9390
9461
9462
9463
9490
9560
9561
9562
9563
9590
9690
9790

NAME OF ENTRANT
(How it is to be printed in program)

Number of
groups to
be entered
in this class

Number of
performers
in group

ENTRY FEE

10 yrs/u TAP
12 yrs/u TAP
14 yrs /u TAP
Open Tap
8 yrs Classical
10 yrs Classical
12 yrs Classical
14 yrs Classical
Open Classical
Open National
10 yrs Contemporary
12 yrs Contemporary
14 yrs Contemporary
Open Contemporary
10 yrs Modern
12 yrs Modern
14 yrs Modern
Open Modern
8 yrs JAZZ
10 yrs JAZZ
12 yrs JAZZ
14 yrs JAZZ
Open JAZZ
Open HIP HOP
Open Entertainment

SUB TOTAL

Entry form must be accompanied by FULL ENTRY FEE, paid by CHEQUE/MONEY ORDER made payable to City of Dubbo
Eisteddfod Inc. OR DIRECT DEPOSIT to BSB: 932 000 ACC NO: 26026. Attach EFT receipt with entry form.

Office Use Only

Entry No: _______

Payment Received: __________________________________________________

Notes: _____________________________________________________________________________________