2015 首届福田杯全国青少年钢琴精英赛报名表参赛资料 Competition information: 请以正楷填写此表格 Please complete this form in BLOCK LETTERS. 比赛组别名称 Competition Class Name 比赛曲目 Repertoire(s) 个人资料 Personal Particulars: （ * 为必填项目。报名者如未满 18 岁表格须由家长 / 监护人填写） * 出生日期 Date of Birth_____________________ * 手机号码 Mobile No. _________________ * 电邮 E-mail____________________________________________________________________________ 片 * 性别 Gender________________________ 照 * 中文姓名 Name__________________________ * 家长 / 监护人姓名 Parent/Guardian’s Name_________________________________________________ * 证件类型 Type of ID________________ * 证件号码 ID No._________________________________ * 通信地址 Correspondence Address________________________________________________________________________________ * 钢琴导师姓名 Name of Piano Tutor___________________ * 钢琴导师电话 Tutor’s Phone No. ___________________________ * 培训中心 / 推荐人 Presented by ________________________________________________________________________________ 钢琴导师 / 培训中心联系地址 Address of Piano Tutor_______________________________________________________________ * 钢琴导师电邮 E-mail_________________________________________________________________________________________ 声明 Declaration: 1. 本人声明在此报名表格及随附文件所载的资料，依本人所知均属完整真确。 I declare that all information provided in this application form and the attached documents are, to the best of my knowledge, accurate and complete. 2. 本人同意如本人获取比赛资格，本人当遵守福田杯全国青少年钢琴精英赛的规例。 I consent that if admitted, I will comply with all the Rules and Regulations stipulated by the committee Futian National Piano Competition For Young Piantists . 3. 本人已细阅比赛章程内之申请须知，并明白所有报名须知详情均以网页之最后更新版本为依归。 I have read the “Rules and Regulations” in the Competition Syllabus and understood that the details are subject to the lastest updates in the Hong Kong Piano Music Association website. 地址：深圳市南山区华侨城深南大道 9028 号郎朗音乐世界（威斯汀酒店对面）电话：+86 755 2690 3421 邮编：518053 Email:[email protected]