W P T A I P C A P P L I C A T I O N F O R M

COMPOSING CATEGORY

First (Given) Name:

Last (Family) Name:

Gender (delete as appropriate): MaleFemale

Nationality:

Date of Birth (day/month/year):

Country of Birth:

Address (where currently residing):

Telephone:

Mobile Phone:

Email:

  1. I am applying with the following piece (choose one option):

Solo Piano Piece

Piano Concerto

Other Piece with Orchestra, please specify:

Chamber Music Piece, give details:

Other, please specify:

  1. For WPTA IPC, I provide at least one, or both, of the following (delete as appropriate):

A)score of the piece being submitted for the WPTA IPC

I am sending the score:

- as an e-mail attachment

- it is available for download at the following web-address:

- other, please specify:

B)recording of the piece being submitted for the WPTA IPC

I am sending the recording:

- as e-mail attachment

- it is available for download at the following web-address:

- other, please specify:

  1. Title of the submitted piece:
  1. Length (approximate) of the submitted piece:
  1. Instrumentation of the submitted piece (give all instruments required for performance):
  1. The submitted piece is published: YES or NO

If YES, please provide the name of the publisher, and the year of publication:

  1. The submitted piece has been performed: YES or NO

If YES, please provide the venue title, and the year of (first) performance:

  1. Application fee payment details

Please visit and follow instructions to make payment. You will then receive an electronic remittance slip which you must forward to

In addition please provide this information (delete as appropriate):

Last four digits of the credit/debit card used for payment:

or

I used Pay-Pal for the payment

  1. Other materials

Please send a colour photograph and biography in English to

By typing my name below and sending this Application Form to WPTA IPC, I state that all information given here and in my biography is true. I agree to the WPTA IPC rules and accept as final the decisions of the competition jury. I also testify that the piece submitted for the WPTA IPC is my own, original work.

First and Last Name

Date

Please send all correspondence, Application Form and materials to