Entry Form – Franklin Pond Chamber Music

ENSEMBLE INFORMATION

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Ensemble Name *

This name will be used in all print and digital material posted by Franklin Pond. Do not name it after a school or community organization (for example: Coffeetown High School Quartet or Coffeetown Youth Orchestra Horn Trio)

Division *

MIDDLE SCHOOL (majority of players are in 6th-8th grade)
HIGH SCHOOL (majority of players are in 9th-12th grade)

If there are an even number of players in middle and high school, then ensemble shall enter into the HIGH SCHOOL division

Is the ensemble eligible for the School Prize?

Ensembles whose members all attend the same school are eligible for the School Prize

Number of musicians in ensemble *

What school do all ensemble members attend?

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How did you learn of the FPCM Competition? *

Private Teacher/Coach
School
Other students
Other parents
Youth Orchestra
Website
Print ad (magazine, program, etc.)
All-State
Other

Please check all that apply.

Which teacher or coach?

Which school?

Which orchestra?

Where did you see the print ad?

Please specify "other"

PRIMARY CONTACT INFORMATION

The primary contact is a representative of each group with whom Franklin Pond will communicate. They will then be responsible for sharing information with their ensemble.

Primary Contact Person Name *

Contact Person Status *

Ensemble member
Parent
Other

Primary Contact Person Email *

Email is the primary mode of communication. Please provide an accurate email address and check email frequently.

Primary Contact Person Phone *

Does the ensemble includes at least one member with a U.S. tax identification or social security number? *

In compliance with IRS requirements, at least one member of a prize winning ensemble (or guardian if under 18) must have a valid U.S. Social Security number or U.S. Tax ID number; otherwise, a percentage of winnings will be withheld for federal taxes.

The ensemble's contact person must certify the following statement:

"By checking the box below, I verify that this ensemble meets all eligibility and entry requirements. I affirm that each ensemble member is aware of, and will abide by, all competition rules. Each member is informed of, and accepts, all responsibilities implied and stated with this entry into the competition."

I agree

Name *

Date *

ENSEMBLE MEMBER INFORMATION

Member 1

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Ensemble Member 1 Name *

Birthdate *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Instrument *

Age (on 5/28/24) *

Email *

Phone

Leave field blank if student does not have a phone number.

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Parent/Guardian Name(s) *

Parent/Guardian Email *

Parent/Guardian Phone *

Is the Parent/Guardian address the same as the Ensemble Member 1 address?

Parent/Guardian Address *

Address Line 1

Address Line 2

City

State

Zip Code

Member 2

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Ensemble Member 2 Name *

Birthdate *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Instrument *

Age (on 5/28/24) *

Email *

Phone

Leave field blank if student does not have a phone number.

Parent/Guardian Name(s) *

Parent/Guardian Email *

Parent/Guardian Phone *

Is the Parent/Guardian address the same as the Ensemble Member 2 address?

Parent/Guardian Address *

Address Line 1

Address Line 2

City

State

Zip Code

Member 3

Ensemble Member 3 Name *

Birthdate *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Instrument *

Age (on 5/28/24) *

Email *

Phone

Leave field blank if student does not have a phone number.

Parent/Guardian Name(s) *

Parent/Guardian Email *

Parent/Guardian Phone *

Is the Parent/Guardian address the same as the Ensemble Member 3 address?

Parent/Guardian Address *

Address Line 1

Address Line 2

City

State

Zip Code

Member 4

Ensemble Member 4 Name *

Birthdate *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Instrument *

Age (on 5/28/24) *

Email *

Phone

Leave field blank if student does not have a phone number.

Parent/Guardian Name(s) *

Parent/Guardian Email *

Parent/Guardian Phone *

Is the Parent/Guardian address the same as the Ensemble Member 4 address?

Parent/Guardian Address *

Address Line 1

Address Line 2

City

State

Zip Code

Member 5

Ensemble Member 5 Name *

Birthdate *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Instrument *

Age (on 5/28/24) *

Email *

Phone

Leave field blank if student does not have a phone number.

Parent/Guardian Name(s) *

Parent/Guardian Email *

Parent/Guardian Phone *

Is the Parent/Guardian address the same as the Ensemble Member 5 address?

Parent/Guardian Address *

Address Line 1

Address Line 2

City

State

Zip Code

Member 6

Ensemble Member 6 Name *

Birthdate *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Instrument *

Age (on 5/28/24) *

Email *

Phone

Leave field blank if student does not have a phone number.

Parent/Guardian Name(s) *

Parent/Guardian Email *

Parent/Guardian Phone *

Is the Parent/Guardian address the same as the Ensemble Member 6 address?

Parent/Guardian Address *

Address Line 1

Address Line 2

City

State

Zip Code

Member 7

Ensemble Member 7 Name *

Birthdate *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Instrument *

Age (on 5/28/24) *

Email *

Phone

Leave field blank if student does not have a phone number.

Parent/Guardian Name(s) *

Parent/Guardian Email *

Parent/Guardian Phone *

Is the Parent/Guardian address the same as the Ensemble Member 7 address?

Parent/Guardian Address *

Address Line 1

Address Line 2

City

State

Zip Code

Member 8

Ensemble Member 8 Name *

Birthdate *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Instrument *

Age (on 5/28/24) *

Email *

Phone

Leave field blank if student does not have a phone number.

Parent/Guardian Name(s) *

Parent/Guardian Email *

Parent/Guardian Phone *

Is the Parent/Guardian address the same as the Ensemble Member 8 address?

Parent/Guardian Address

Address Line 1

Address Line 2

City

State

Zip Code

ENTRY VIDEO, SCORE, AND PICTURE UPLOAD

Video Submission Link *

Please be sure your YouTube link is marked as UNLISTED. This can be done in the video upload settings on YouTube.

If your ensemble has a high resolution photo, please upload it.

Click or drag files to this area to upload. You can upload up to 3 files.

A photo of your ensemble is not necessary but highly encouraged. Ensemble photos will be displayed on the Franklin Pond website as well as other media outlets.

Score Upload *

Click or drag a file to this area to upload.

Please upload ONLY the movement being performed. Do NOT upload the entire chamber work.

Composer *

Title of Piece *

Name of Movement *

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