NATIONAL EISTEDDFOD OF SOUTH AFRICA™

ENTRY FORM FOR INDIVIDUAL ENTRIES2017

Complete all Sections

A.RESPONSIBLE PERSON / INSTITUTION

A.1 Who is responsible for submitting this entry?
(Select one of the 3 options in the columns on the right). / SCHOOL / STUDIO / PARENT
A.2. Provide the NAME of the option selected in A.1
A.3 Who will submit the applicable entry fees to the NEA? / SCHOOL / STUDIO / PARENT
NOTE: You will participate in the region as selected by the registered school/studio/parent in A2.
(All communication about this entry will go to this school / studio / parent. This name will be printed on the certificate if no other information is provided in B or C.)
A.4. If the participant is receiving training from different teachers / studios in the various items listed in table C, the NAME of these trainers/studios must be provided next to the entry on the entry list. (This name will be printed on the certificate as Trained by [Name of Trainer], provided that this studio/teacher has been registered on the NEA database).
B. PROFILE OF PARTICIPANT
NAME / SURNAME
COMPULSORY INFORMATION: Entries cannot be processed without an ID Number OR Date of Birth
ID number or
Date of birth / YEAR / MONTH / DAY / Female / Male
NAME OF SCHOOL / (This refers to the public / private school the participant is attending.)
School Grade
( when applicable) / Language of communication
E-mail of parent / participant
Cell No. of parent (1) / ______-______-______/ Cell of parent (2) or participant: / ______-______-______
*Kindly provide the disability code where applicable / * / A Blind / Partially sighted / C Intellectually
challenged / E Physically challenged
B Deaf/Hard of Hearing / D Learning disabled / Not Applicable
NB!! If you wish the NEA to consider any particular request when scheduling your items, please complete the Special Request form on the next page.Any notes regarding “special requests” on this entry form will be disregarded. / New to the NEA?
YES / NO

I accept the Rules and Regulations of the National Eisteddfod Academy as outlined in the Prospectus and on the web page. I accept that entry fees are not refundable and that it remains my responsibility to contact the NEA if I have not received notification of performance dates at least 7 days prior to the starting date of events in my region. I accept the decision of the NEA management about all matters regarding this event. I accept that the NEA and its host venues are indemnified against any loss, theft of injury sustained during this festival. I hereby authorize the NEA to use recordings / pictures of performances at some of NEA events on the NEA’s social platforms and website.

______

Name in PrintSignatureDate

C. DETAILS OF ENTRY / ENTRIES

CATEGORY / SECTION NUMBER / GRADE CODE / Name of “Trained by” institution / When in doubt, provide brief detail of item for referencepurpose.
Example / B / B / 3 / 0 / 3 / 1 / 0 / 4 / 0 / 9 / “The Music Studio –Vocal pop solo with b/t”
1.
2.
3.
4.
5.
6.
7
8
9
10
IMPORTANT NOTICE:
Individual participant slips will in future only be mailed on REQUEST to the e-mail address of the responsible school / studio / parent (see A.2 above).NB! Contact the NEA office if notification of performance dates has not been received at least 7 days prior to the starting date of events in your region. Please ensure to return the check list that will be sent to you for verification on time.
More entries may be added on additional pages.Clearly provide your name on all additional pages.
Number of entries / Entry fee / TOTAL AMOUNT DUE
X / R______ / R

HARDCOPY ENTRY FEE PER ITEM:

Confidence Builder (until 10 June):R 80

Early Bird Fee (until 15 May):R175

Standard fee (until 10 June):R195

Late entries(until 30 June):R295

DETAILS OF PAYMENT: Please indicate with √ in appropriate blocks where applicable

CASH / CHEQUE / E
F
T / DATE OF ELECTRONIC TRANSFER / COMPULSORY:
Provide Reference Number for Institution on the deposit slip.
Fax proof of transfer to [011] 787 3534 / Reference Number for Institution
____/____/2017
Entry fee due: R______ / Bank: ABSA / Account Name:
National Eisteddfod Academy
Branch: Northcliff
Code: 33 47 05 / Account Number: 404 747 8448
Type: Current Account
POSTAL ADDRES: / PO BOX 1288, RANDBURG, 2125

◄Individual Entry Form 2017

SPECIAL REQUEST 2017 FOR INDIVIDUALS

INDIVIDUAL ENTRY / SMALL GROUP ENTRY

For attention: Manager: Administration

National Eisteddfod Academy

Name of participant: ______I.D. Number: ______

I / We kindly request the scheduling of events to accommodate the following activities during the festival period IF and WHEN possible: (Please note: Only activities where the timeframe is fixed and available in advance can be accommodated (e.g. participation in provincial / national events, external exams, etc.)

NATURE OF ACTIVITY
(Provide a brief description of the activities and/or motivate your request) / ACTIVITY DATE(S)
(Block out theUNAVAILABLE dates on the calendar below.)

Calendar for 2017: BLOCK OUT DATES THAT ARE NOT AVAILABLE

July 2017 / Mon 24
Public Schools – Start / Tue 25
ISACA – 4Term schools start / Wed 26 / Thu 27 / Fri 28 / Sat 29
August 2017 / Mon 31 July / Tue 1 / Wed 2 / Thu 3 / Fri 4
ISACA – 3Term schools close / Sat 5
ISACA – 3Term schools close
Mon 7
ISACA – 3Term schools close / Tue 8
ISACA – 3Term schools close / Wed 9
Women’s Day / Thu 10
ISACA – 3Term schools close / Fri 11
ISACA – 3Term schools close / Sat 12
ISACA – 3Term schools close
Mon 14
ISACA – 3Term schools close / Tue 15
ISACA – 3Term schools close / Wed 16
ISACA – 3Term schools close / Thu 17
ISACA – 3Term schools close / Fri 18
ISACA – 3Term schools close / Sat 19
ISACA – 3Term schools close
Mon 21
ISACA – 3Term schools close / Tue 22
ISACA – 3Term schools close / Wed 23
ISACA – 3Term schools close / Thu 24
ISACA – 3Term schools close / Fri 25
ISACA – 3Term schools close / Sat 26
ISACA – 3Term schools close
Mon 28
ISACA – 3Term schools close / Tue 29
ISACA – 3Term schools close / Wed 30
ISACA – 3Term schools close / Thu 31
ISACA – 3Term schools close / Fri 1 Sept
ISACA – 3Term schools close / Sat 2 Sept
ISACA – 3Term schools close
Sept. 2017 / Mon 4
ISACA – 3Term schools close / Tue 5
ISACA – 3Term schools start / Wed6 / Thu 7 / Fri 8 / Sat 9
Mon 11 / Tue 12 / Wed 13 / Thu 14 / Fri 15 / Sat 16
Mon 18 / Tue 19 / Wed 20 / Thu 21 / Fri 22 / Sat 23
Mon 25
Public School Holiday / Tue 26 / Wed 27 / Thu 28 / Fri 29
Public / ISACA 4 Term schools close / Sat 30
Public / ISACA 4 Term schools close
Oct. 2017 / Mon 2
Public / ISACA 4 Term schools close / Tue 3
Public / ISACA 4 Term schools close / Wed4
Public / ISACA 4 Term schools close / Thu 5
Public / ISACA 4 Term schools close / Fri 6
Public / ISACA 4 Term schools close / Sat 7
Public / ISACA 4 Term schools close
Mon 9
Public Schools start / Tue 10
ISACA 4 Term schools close / Wed 11
ISACA 4 Term schools close / Thu 12
ISACA 4 Term schools close / Fri 13
ISACA 4 Term schools close / Sat 14
ISACA 4 Term schools close

Please note: Incomplete forms cannot be processed.

IMPORTANT: SPECIAL REQUESTS SHOULD BE SUBMITTED WITH THE ENTRIES

DEADLINE FOR SUBMISSION:10JUNE 2017

Although the NEA will attempt to accommodate all reasonable requests,

NO guarantee can be provided.

◄Individual Entry Form 2017