Young Artist Competition Survey

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ARIZONA YOUNG ARTISTS' COMPETITION

Everyone registering online MUST pay online FIRST - click here to pay online (you may register for more than one discipline; $25 each discipline). After you pay the $25 fee, please enter order number you will receive after payment has been made.

1. Enter your Order Number here:

2. Name:

3. Parent Name (if under 18):

4. School or Studio Name:

5. Street Address:

6. City:

7. State:

8. Zip Code:

9. Birthdate (mm/dd/yyyy):

10. Phone (with Area Code):

11. Alternate Phone (with Area Code):

12. Email Address:

13. In what category would you like to compete? (you may register for more than one discipline; $25 for each discipline):

	Acting
	Dance
	Voice

14. Will you bring your own accompanist? (an accompanist will be provided if you do not bring your own. No self-accompanying or taped accompaniment.):

	Yes
	No

15. Please provide the name of your accompanist, if you are bringing one::

16. How did you hear about the Arizona Young Artists' Competition? :

	Website
	Teacher
	TV
	Radio
	Newspaper/Magazine
	Friend
	Other

17. Have you previously participated in the Arizona Young Artists' Competition?:

	Yes
	No

18. Are you a U.S. Citizen?:

	Yes
	No (if no, contact the Herberger Outreach Department, 602-254-7399 x104

Terms & Conditions:

O I understand these qualifications for participation in the Arizona Young Artists' Competition and agree to abide by them. I grant permission to the Herberger Theater Center and Center Dance Ensemble to use my image and likeness for promotional purposes. I release and hold harmless the Herberger Theater Center and Center Dance Ensemble of all liability with regard to my participation in this competition.

O I do not agree and therefore will NOT be entered in the Arizona Young Artists' Competition.

REGISTRATION FORMS AND PAYMENT MUST BE RECEIVED BY MIDNIGHT ON APRIL 1, 2012.