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*
Preferred Date 1*
Special Requirements
Eg: Number of Microphone , stand ect.
Rehearsal options (program will be removed if one of option is not completed)*

Submitting the actual full performance video and actual song one week before the eventAttending a Rehearsal session at Ballarat High School (Venue) on Sep 6 Friday between 6-9 pm.
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.I grant permission to BHTCC to use my photos and videos on Youtube, Facebook, Web site, and other social media platforms.I/We hereby agree that I/we have read this agreement and am/are bound by it.
Signature*

Clear
Date Signed

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

Bhandhavi
Email: ballarathindutemple@gmail.com
Upload Dance song(If applicable):

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Expression of Interest & Media Consent Form