Rotary District 1070 Youth Service

District 1070

Rotary District 1070 Youth Service

Young Musician Entry Form 2017-2018

PLEASE COMPLETE IN BLACK INK AND CLEAR CAPITAL LETTERS AS THIS INFORMATION ISUSED FOR CERTIFICATES AND LATE MAILINGS OF ESSENTIAL INFORMATION TO ENTRANTS

Sponsored by The Rotary Club of ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………

Name of Entrant(s) Note if you are an ensemble; please list all your names on the back of this form

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………………………………..

Email ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………...………..…………..

Full Contact Address …………. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….……..……………..

To which information will be sent

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Post Code (essential)………………………………………………………………………………………………………………………Telephone Number…………………………………………………………………………………………………….………

Date of Birth (of oldest, if group or ensemble)…………………………………..….Junior ………………..………Intermediate………………….………Senior………………………..…… (Please tick)

Solo ……………………………………….………Ensemble (2-5 Players) …………………..……………………………… Group …..………………………………….……………Choir …………..……………………….………(Please tick)

Instrument to be played / vocal ………………………………………………………………………………………….………… Number in Choir or Group………………………………………………………..………………..

Composition Composer(s)

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….…………..

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….……………………………..

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….…………………………..

Length of Performance ………………………………………………………………………………………………….……..Minutes (see Rule 13) Please be as accurate as possible to help scheduling

Name of Accompanist, to be printed in programme (see Rule 14)……………………………………………………………………………………………………………………………………………………………………

Photographic/video records of entrantsmay be taken and used for Rotary International in Great Britain and Ireland (RIBI) publicity purposes in printed, electronic and online formats.These will not be used unless the consent of the child and their parents/guardians/carers has been obtained. All reasonable measures will be taken to ensure these images are used solely for publicity of the event.

1. I/We have read , understand and agree to the Rules of the Rotary Young Musician Competition.

2. Consent to photographic/video records being taken of the person(s) named above at the Rotary Young Musician event.

Print name (entrant) ……………………………………………………………………………………………………………………………Signed ……………………………………………………………….………………Date………………………………..………..

Print name ……………………………………………………………………………………………………………………………………….…………..Signed …………………………………………………………….…………………Date…………………………..…………….

(Parent/Guardian/Carer)

Signed (Sponsoring Rotary Club) …………………………………………………………………………………………………………………………………………………………………….……………………….…Date……………………….………………..

This form must be returned by the sponsoring Rotary Club along with the appropriate fee by 9th February 2018to

Moira Bartlett (Rotary Club of Leicester)email:

LATE ENTRIES WILL NOT BE ACCEPTED

Full Rules for this competition can be found at

Fees: Solos £6.00, Ensembles £12.00, Choirs & Groups £20.00 per entry.

Please make cheques payable to Rotary District 1070