Ballet Nights Young Ambassador Malaysia
Application Form
PERSONAL DETAILS
Student Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Gender
*
Please Select
Male-identifying
Female-identifying
Prefer not to disclose
Are you a Malaysian Citizen?
*
Please Select
Yes, I hold citizenship & I am training
Yes, I hold citizenship & I am working
No, but training or living full time in Malaysia
Vocational/Dance School Student Currently Attends
*
If permission is required, please seek this from the Director/Principal of your school
Awards and Achievements
Please add as appropriate
PARENT/CARER DETAILS
Parent/Carer Full Name (If under 18)
First Name
Last Name
Parent/Carer Email (if under 18)
example@example.com
Parent/Carer Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
PAYMENT
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Registration Fee
*
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Ballet Nights Young Ambassador Malaysia
Audition will take place on the 13th of December
100.00
MYR
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Would you like to be added to the Ballet Nights Mailing list for exclusive access to show updates, behind-the-scenes insights, performer spotlights, and priority offers for Ballet Nights events in South East Asia?
*
Please Select
Yes
No
Submit
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