<p> 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.</p><p>1. Last Name 2. Last Name 1. First Name 2. First Name Home Phone Mobile Phone Email Club State Coach 1 Coach 2 </p><p>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</p><p>Music Details Overall Duration 1st Cut Duration Disc/Tape No </p><p>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 </p><p>Date Competitor’s/Parent’s Name Signature </p><p>071d78cead383dc6f37eabf4d1c67ad8.doc Page 1 of 1</p>