REGISTRATION
FOR THE INTERNATIONAL CONTEST of the RIC 2012
Eliminatory Round: January 14 – 15, 2012
1) To register, please fill in this form and send back to:
Dr. Jean-Christophe Dobrzelewski
West Chester University of Pennsylvania
College of Visual and Performing Arts
Swope Music Building
817 South High Street
West Chester, PA 19383
Please direct questions to regional host:
Via email: jdobrzelewski@wcupa.edu
Or
By phone: Dr. Jean-Christophe Dobrzelewski – (610) 436-2928
2) Please fill in the following pieces of information:
- LAST NAME:
- FIRST-NAME:
- ADDRESS:
- INSTRUMENT:
- TELEPHONE NUMBER:
- CELLPHONE NUMBER:
- CHOSEN REPERTOIRE: (composer, title, and movement if applicable)
- Will the performer be alone or accompanied? ALONE / ACCOMPANIED?
(underline)
- CHOSEN CATEGORY : TAKE CARE ONLY CATEGORY 3 IN USA !!!!
( age dated on 30th March 2012) (underline)
1) 12-14 years old 2) 15-17 years old 3)18-23 years old
3) Please send the following documents: (un-complete forms will not be
accepted)
- A photo
- A copy of your identity card / or passport
- For minors (under the age of 18), a written proof of consent signed by the
parents or a legal guardian is required..
-
4) For payment :
Enrollment fee: $100 Dollars
Registration will not be valid until payment has cleared.
Bank’s name and address:
Payment by check only!
Payment: Please write checks to "WCU Chapter of ITG"
Dr. Jean-Christophe Dobrzelewski
West Chester University of Pennsylvania
College of Visual and Performing Arts
Swope Music Building
817 South High Street
West Chester, PA 19383
Registration Deadline: January 1st, 2012 (postmarked)
By signing this document you testify that you have read and agree with the rules
on the competition website: www.imepric.com .
Please sign and write “ read and approved”
I have read and agree with the rules on the competition website. I fully
understand that entering the eliminatory rounds does not automatically qualify
me for the finals in Belgium. Selection of finalist(s) will be by jury decision
only.
Type Name: _________________________________
Signature: ___________________________________
Date: _______________________________________