Surname and name:

Category: couple ; soloist 

Date of birth: day  month  year 

Place of birth: 

At the competition, I represent (name of the country):

Place of employment or study:

Name(s) of school(s) attended:

Date of graduating: 

Surname and name of the teacher at school (with indication of his/her honours):

Surname and name of the partner (with indication of his/her honours):

Surname and name of the coach (with indication of his/her honours):

Home address:

Phone number: 

Fax: 

E-mail: 

Round I. Classical choreography

Number 1

Name of the Work:

Performance time: 

Composer: 

Choreographer: 

Number 2 — for soloists

Name of the Work:

Performance time: 

Composer: 

Choreographer: 

Round II. Classical choreography

Number 1

Name of the Work:

Performance time: 

Composer: 

Choreographer: 

Number 2 — for soloists

Name of the Work:

Performance time: 

Composer: 

Choreographer: 

Round II. Contemporary choreography

Name of the Work:

Performance time: 

Composer: 

Choreographer: 

The Work was staged in: 

Specially for the Competition:  Yes   No

Round III. Classical choreography

Number 1

Name of the Work:

Performance time: 

Composer: 

Choreographer: 

Number 2 — for soloists

Name of the Work:

Performance time: 

Composer: 

Choreographer: 

I accept the rules of the Competition.

Signature:   Date: