American Protégé

Summer Gala Concert at Stern 2019

APPLICATION FORM

only for applicants with financial sponsorship

Please fill out the Application form and click SUBMIT button at the end of the form to complete your registration for the Summer Gala Concert at Stern.

Fields marked with “*” are mandatory.

First Name *

Last Name *

Age *

Date of Birth *

Gender: *

Instrument *

Solo/Ensemble *

Email *

Additional Email

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Please enter your Repertoire in the spaces provided below:

Composer: *

Title: *

Time: *

YouTube Link:

Please enter your teacher's information:

Teacher's Name 1:

Teacher's email 1:

Teacher's Name 2:

Teacher's email 2:

Confirmation of Sponsorship:

Confirmation: *

By checking this box, I certify that I have confirmed sponsors who are willing and able to contribute $2,500 by December 15, 2018, as a concert fee for the American Protégé Summer Gala Concert at Stern 2019.

Consent to the Competition Rules and American Protégé Policies:

Consent: *

By checking this checkbox I confirm that I have read, and agreed to abide by, the American Protégé Policy and all procedures and rules of the American Protégé Summer Gala Concert at Stern 2019. I certify that the information given on this application form is correct. I understand that incomplete applications (including failure to pay fees and failure to fill in the form properly) will result in disqualification, and that all decisions made by the panel of judges are final and may not be appealed.

Applicant's or Parent/Guardian's Name: *

Today's Date: *

Name