Ślimakowe Rytmy – Beats of Cochlea

First Name

Surname

Date of birth

E-mail

Phone numer including country code

Street

Postal code

City

Country

Are you an implant user?

YesNo

Type of the performance

vocalinstrumentalvocal-instrumental

Original title of the composition that you will perform

Name and surname of the original performing artist; if the performing artist is unknown write "unknown performer"

Name and surname of the composer; if the composer is unknown write "unknown composer"

Write us some sentences about yourself – what do you do in life (work, school, hobbies), how did you lose your hearing, how did you feel about it? What does the music mean to you? Describe your musical passion – when and why you became interested in music, which instrument(s) you like to play, what songs you like to sing, and your favorite music genre. What do you consider your greatest musical success?
(maximum 500 words)
(required field - max 1000 characters):

Video attach
Video recording of your performance with good quality sound. File names should include only alphanumeric signs; max. 25MB; accepted file formats: mp3, wma, wmv, mp4, avi.

Your performance:
(the file name should comprise only alphanumeric characters; max. 25MB - file format: mp3, wma, wmv, mp4, avi, mov)

Portrait photo of the participant
(minimum 1MB - maximum 5MB, file types: jpg, png)

I agree on my personal data presented in the registration form to be processed by the Institute of Physiology and Pathology of Hearing based in Warsaw 02-042, ul. Mochnackiego 10, pursuant to the rules set out in the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation).

Upon registration I declare that I have read and fully accept the Bylaw of the Festival.

Upon registration I confirm that I agree on the publication of my image and the composition performed by me for marketing purposes of the Organizers and Partners of the Organizers in compliance with the Festival Bylaw.

Upon registration, I declare that I have read the GDPR information clause and fully accept it.

Minors must provide signed Parental (Legal Guardian) Consent to enter Festival competition – required form is available for download here.