BHTCC GC Perfomers EOI Form

Expression of Interest & Media Consent Form

Expression of Interest & Media Consent Form
Guardian /contact person's Name
Participant Name

First NameLast Name
Age Group
Email ID
example@example.com
Phone Number

Area CodePhone Number
Performance Name
Eg: Bollywood Group Dance By Name
Location
Eg: Melbourne, Ballarat ect
Group Name (If applicable)
Group Members list of full Name ( if applicable)
Short synopsis of Performance
please provide a short description of the performance to announce at the start
Duration of performance
Performance Date
Rehearsal Time slot on 18/09/26 Friday
Special Requirements (Mic, stand, cable, Instruments ect)
Eg: Number of Microphone , stand ect.
Rehearsal options (program will be removed if one of option is not completed)
Authorization and Release Agreement

I grant permission to BHTCC and its agents or employees to use photographs and/or video and audio taken of me. These images may be used in educational, documentary and commercial materials such as Public Service Announcements, Grant Applications, Video Documentaries, Commercial Television and both printed and online newsletters and newspapers. Furthermore, I authorise the use of my image, likeness, and voice for all program promotion, materials, and any other purposes in connection with the program deemed appropriate and necessary by BHTCC.
Signature
Date Signed

MonthDayYear
Date
Contact Info:
The Ballarat Hindu Temple & Cultural Centre INC (BHTCC )

Bhandhavi
Email: festivals@bhtcc.org.au
Upload Dance song(If applicable):

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Expression of Interest & Media Consent Form