Full Name*

Contact Number

Your email*

Emergency Contact Name*

Emergency Contact number*

Do you have any medical issues that we need to be aware of during the program?*

Media Release: "Photograph and audio recording release for the purpose of promotional and media photographs, and audio recording, throughout the event. I grant Women in Brass, its agents and approved media, the irrevocable and unrestricted right and permission to use any photo and or recording of me, or in which I may be included in, in any media hereafter known for any other purpose whatsoever. I hereby release the Women in Brass, the photographer and their agents and assigns from all claims and liability relating to the use of the said recording and photographs.*

Yes

No

I hereby accept the offer made to me to participate in Women in Brass and agree to all conditions as stated in the congratulations email.*

Yes

No

Submit

Acceptance Form

NB: All information on this form is confidential and will only be shared with the Chairperson and the MD.
All data (excluding the media release) will be destroyed after the concert.