2022 2023 Entry Form Last modified on May 27, 2022 by Alex Hatzipanis Before you complete the Entry Form you must have read the “Rules and Conditions”. Entries close Friday 14th October 2022. An entry fee of $120.00 MUST be sent via online banking number: 38/9010/0480141/00 – please put name in reference. Surname*Given name(s)*Address*Post Code*Email address* Phone (home)*Phone (mobile)*Place of Birth*Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Details of Concerto to be played Including opus number eg Piano Concerto no 4 in G major op 58Concerto*Composer*Number and name of each movement to be played (with approximate duration)*Details of instrumentation required for a full orchestral performanceDetails of instrumentation required for a full orchestral performance*AccompanistAccompanist Name*Accompanist Phone*We have included two accompanists. If you wish to make contact with them for the competition please contact them directly on the cell phone number and emails provided in the "Rules and Conditions". I hereby undertake to abide by the rules and conditions of this competition and to accept the decisions of the adjudicator(s) as final and agree that no correspondence will be entered into.Signed*Note: If under 18 years of age on 31 December 2022, please have a parent or guardian complete the declaration of consent. Declaration of consent by parent or guardian Required in the case of an entrant under the age of 18 years on 31st December, 2022. Being under the age of 18 years on 31st December 2022, the entrant has obtained my consent to enter for and take part in the 2022/2023 CCMC National Concerto Competition®. I have read and fully understand the rules and conditions of this Concerto Competition. In consideration of your accepting this entry, I, the undersigned, being the parent/guardian of the above-named entrant, hereby indemnify the Christchurch Civic Music Council National Concerto Trust in respect of any loss, injury, or claims, costs, actions, and damages referred to in Rule 9.Parent/guardian NameParent/guardian Name AddressParent/guardian DateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.