APPLICATION FORM 2011	
	
First (and middle) name					Last name	
	
Nationality / Country represented			Country of residence	
	
Mailing address	
	
Telephone							Mobile phone	
	
E-mail	
	
Permanent adress (if different from above)	
	
Telephone	Fax	
	
Date of Birth	
	
Application CD or DVD	
	
A work by Haydn or Mozart      duration	
	
A romantic work from the 19th century (including Scriabin and Rachmaninov)  duration	
	
1st round: Free repertoire of 25-30 minutes (list the works you want to play and the timing of each piece)	

	
2nd Round: Free repertoire of 35-40 minutes (list the works you want to play and the timing of each piece)	

	
Final: a list of piano concertoes wil be published medio September on our website. Please, list two concertoes as your choice.	
	
I have read the conditions of the competition and agree :	
	
Signature	Date	

parent/guardian signature	Date	
(if the contestant is under 18)