19 Annual Ameropa 2012
~ Application form ~
Total price:
€
AMEROPA Participant type
1. Active program
-
Ameropa Active participant
Scholarship - Solo included - 10%
Scholarship - Repeated participant - 10%
Special bonus - Early apply discount - 10%
Youth Program
Ameropa Intensive Program
Active participant - first week
Active participant - second week
Student ZUŠ - Praha 6 nebo Brandýs n. Labem
* must be filled
I participated in Ameropa in years
(needs to be filled if you apply for repeated discount)
2. Passive program
-
Passive participant
Passive participant - one week
Passive family members
Passive family members - one week
3. I would like to participate in Ameropa Concertante Competition
AMEROPA CONCERTANTE COMPETITION »»
Application for download -
here
4. AMEROPA Solo Masterclasses
I do not apply for Solo Masterclasses
Solo Active participant
Solo Passive participant
5. Application fee requested from each participant
NOTE: Participants requesting
Ameropa Intensive Program
will be chosen by Ameropa faculty board. Recording of 2 contrast movements is requested till April 30, 2012. We will inform you about the AIP program and the scholarship competiton results in due time.
Special bonus
- Christmas discount 10% is valid for applications sent till January 31st, 2012.
Last Minute program
will be decided in May and for needed instruments only. >
Personal information
6. First name, middle name
7. Last name
8. Gender (Male-M, Female-F)
M
F
9. Date of birth
(if you don't mind...)
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
10. Nationality
Choose Your Nationality
Albanian
American
Andorran
Australian
Austrian
Belgian
Belorussian
Bosnian/Herzeg.
Brazilian
Bulgarian
Canadian
Chinese
Croatian
Cyprian
Czech
Dane
Dutchman
English
Estonian
Finlandian
French
German
Greek
Hungarian
Icelander
Irelander
Israeli
Italian
Jamaican
Japanese
Korean
Latvian
Liechtensteiner
Lithuanian
Luxembourger
Macedonian
Monegasque
New Zealander
Norwegian
Polish
Portuguese
Romanian
Russian
Scotsman
Slovak
Serbian
Slovenian
Spaniard
Sweden
Swiss
Taiwanese
Turk
Ukranian
Yugoslavian
Rest of the World
Please state your nationality (-ies), if not listed above or if multiple applies
11. Address - Street
City / Zip Code
12. Country
Choose Your Country
Albania
Andorra
Australia
Austria
Belgium
Belorussia
Bosnia/Herzeg.
Brazil
Bulgaria
Canada
China
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Finland
France
Germany
Greece
Greenland
Hungary
Iceland
Ireland
Israel
Italy
Jamaica
Japan
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Monaco
Netherlands
New Zealand
Norway
Poland
Portugal
Romania
Russian Fed.
Serbia
Slovak Republic
Slovenia
South Africa
South Korea
Spain
Sweden
Switzerland
Taiwan
Turkey
Ukraine
U. Kingdom
U.S.A.
Vatican State
Fed. R. of Yugosl.
Rest of the World
Please state your country, if not listed above or if multiple applies
13. Primary e-mail
* must be filled
Other emails (if you use more, please type all possibilities)
14. Mobile phone, if we need to contact you
15. Your personal web page, if you have it
16. Health or mobility conditions that we need to know about
17. Are you vegetarian or do you have any dietary needs?