The Fifth Canadian Chopin Piano Competition Junior Application Form Your Information Last Name* First Name* Current Address* City* Province* ---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code* Home Phone* Cell Phone Email* Date of Birth* Year200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940 MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day12345678910111213141516171819202122232425262728293031 Place of Birth* Current Teacher* Current Teacher Email* Permanent Address* *IF different from above Address City Province ---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Repertoire Selection for the Competition Etude 1 Title Duration Edition Etude 2 Title Duration Edition Nocturne Title Duration Edition Own Choice Title Duration Edition Signature For applicants under the age of 18, the electronic signature of a parent or guardian is required below. Name of Competitor* Name of Parent or Guardian* Date* Year2019 MonthMarchAprilMay Day12345678910111213141516171819202122232425262728293031 $250 Application Fee* Pay with PayPal I hereby apply to enter the Fifth Canadian Chopin Piano Competition and agree to adhere to all the Competition Rules and Regulations. I agree that by typing my name in the box above, I am electronically signing the application. * Upon submit you will be redirected to PayPal to pay the Junior Application Fee.
