APPLICATION FORM
Must be received by October 3, 2011

Please refer to the Application Checklist for the full requirements of your Application.

(Please print out and complete by typing or printing clearly)

1. Name: Mr. / Ms. _________________________________

2. Birth Date: (mo)_____ /(day)_____ / (yr)______ 3. Age as of November 18, 2011: _________


4. Form of I.D. you are enclosing (copy of): Birth Cert____ Passport____ Driver’s License____

5. Current Address: __________________________________________________________

6. Current Phone: (_____) ________________ 7. Home Phone: (_____) _________________

8. Current Email Address: ______________________________________________________

9. Permanent Address: _______________________________________________________

10. Will you need local accommodations? Yes____ No____

11. How did you hear about The 2011 Heida Hermanns International Piano Competition?
(please select all that apply) Posting at school____ Internet____ My music teacher____

Other (please explain) __________________________________________________________

___________________________________________________________________________


I certify that all information given above is correct to the best of my knowledge. I agree that the decisions of the judges shall be final, that I will make no claims of any kind against the Competition or Connecticut Alliance for Music, Inc., and that I shall assent to and comply with all rules and regulations of the Competition. I understand that the Finals Concert will be recorded and the recordings used by Connecticut Alliance for Music, Inc., for promotional purposes. If I advance to the Finals Concert, I give permission for my performance to be recorded for this use and for my name and biography to be posted on the Connecticut Alliance for Music website. I have made a copy of this application for my own reference.

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The 2011 Heida Hermanns International Piano Competition Application Form, Part 2

PLEASE LIST YOUR COMPETITION REPERTOIRE

For Your Initial Recordings: We require three identical copies. Please DO NOT write your name on the tapes or CDs themselves, but DO print your name and selections on the case or case insert; include titles, keys, movements, opus numbers, etc. Refer to instructions for complete information.

For the Semi-Finals A TYPED LIST IS REQUIRED -
List must be clear.
Use separate sheet if you need more space. THANKS.

Composer-----------------Full Title-------------------------Movements-------------------------Timing

For the Finals PLEASE TYPE PROPOSED FINALS REPERTOIRE HERE. (It will be discussed with the Artistic Director if you proceed to the Finals.)

Composer------------------Full Title-------------------------Movements------------------------Timing

I