Studio Affiliation Form – Eisteddfod of the Performing Arts

Studio Information

* E-mail Address

* Password

Confirm Password

* Name of Studio

* Studio Address

* How many teachers are you affiliating?

Teacher(s) Information

Teacher 1 (of maximum 5)

* 1st Teacher Name and Surname

* 1st Teacher Email

* 1st Teacher Phone number

Teacher 2 (of maximum 5)

* 2nd Teacher or Assistant Name & Surname

* 2nd Teacher or Assistant E-Mail

* 2nd Teacher or Assistant Phone Number

Teacher 3 (of maximum 5)

* 3rd Teacher or Assistant Name & Surname

* 3rd Teacher or Assistant E-mail

* 3rd Teacher or Assistant Phone Number

Teacher 4 (of maximum 5)

* 4th Teacher or Assistant Name & Surname

* 4th Teacher or Assistant E-Mail

* 4th Teacher or Assistant Phone Number

Teacher 5 (of maximum 5)

* 5th Teacher or Assistant Name & Surname

* 5th Teacher or Assistant E-mail

* 5th Teacher or Assistant Phone Number

DECLARATION

* Please confirm

I/We hereby undertake to abide by the Rules and Regulations as set out by the Committee of the Eisteddfod of the Performing Arts at all times.

* Name of teacher

* Affiliation Date

Only fill in if you are not human