2013 NFC Music Form

2016 AUTUMN TROPHY MUSIC FORM Closing date 29 April 2016* *see announcement for exceptions Please read the full announcement, and submit together with the 2016 Autumn Trophy Entry Form and music (to be emailed) by the closing date.

1. Last Name 2. Last Name 1. First Name 2. First Name Home Phone Mobile Phone Email Club State Coach 1 Coach 2

Aussie Skate Singles Adult Free Dance Free 1 Preliminary Copper Elementary Free 2 Elementary Bronze Pre-Primary Free 3 Basic Nov A Silver Basic Novice Free 4 Basic Nov B Gold Adv Novice Pair 1-2 Adv Novice Elite Open Junior Pair 3-4 Junior Master Adult Senior Senior

Music Details Overall Duration 1st Cut Duration Disc/Tape No

Title Composer Orchestra 2nd Cut Duration Disc/Tape No Title Composer Orchestra 3rd Cut Duration Disc/Tape No Title Composer Orchestra 4th Cut Duration Disc/Tape No Title Composer Orchestra

Date Competitor’s/Parent’s Name Signature

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