Registration - Participant Entry Form Before registration, please read carefully Bylaw and GDPR information clause. PERSONAL DATA (all fields required) First Name Family Name Date of birth Nationality CONTACT INFORMATION (all fields required) E-mail Phone numer including country code Street Postal code City Country QUESTIONNAIRE (all fields required) Implantation date Implanted ear rightleftright and left Implant type cochlearmiddle earbone conductionbrainstem Implant manufacturer Implant model COMPETITION INFORMATION (all fields required) 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" Will you need an accompanist during your performance? YesNo Write about yourself and describe your musical passion - Why did you get interested in music? On which instrument do you play or what songs do like to sing the most? Since when do you deal with music? Which genre of music do you like best? What does music mean to you? (required field - max 1000 characters): Describe in a nutshell your medical history - When did your hearing problems begin? What is the history of your treatment, including implantation? How did your rehabilitation look like? Are you satisfied with how you hear with the implant? Did the implant or implants help you develop your passion for music? (required field - max 1000 characters): Your performance of a chosen composition / song : (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.
