International workshop | Registration form

International workshop | Registration form

Please fill in this form carefully.
Student's information

We'd love to know more about you !
Identity

Family nameFirst namePasseport number
Gender
Date of birth

MonthDayYear
Adress

Geographical adress

Adresse complémentaire

City/StateDepartement/region

ZIP code
Email
exemple@exemple.com
Telephone number
Traditional art course
For which edition do you want to register ?
Which level are you ?
NB : Each level refers to one year of engagement of the student during the international workshop of the Conservatory.
Are you going to participate with one of your friend(s) or family ?

YesNo
Do you practice 'ori tahiti, hula or any other kind of dance ? Can you please precise which ones ?
Are you part of a dance group or a dance school ('ori tahiti, hula etc.) ?Which one ?
Image rights

I declare to authorize the artistic Conservatory of French Polynesia to take and use my personal image for communication purposes on all media (print and digital)I refuse to let the artistic Conservatory of French Polynesia photographers' to take my personal image during the workshop.
Should be Empty:

Student's information