Talent Search Entry Form

COUNTRY EXPO TALENT SEARCH

                Entry Form

                                        Please return this section with your payment to:

                                        PO BOX 149 Glasshouse Mountains QLD 4518

Act Name :
Please Circle Appropriate	Solo Duo Trio Group
Postal Address
Email
Phone Number
Ph Contact during Expo
Performer’s History

Signed : ………….………………….(Parents please sign if performer is under 18).

Signature/s ………………………………………… Date ………………………..

____________________________________________________________________

PAYMENT DETAILS (make cheque/money order payable to Glasshouse Mountains Tavern)

$15 entry fee

Cheque Money Order

Visa MasterCard Bankcard Amex Diners

Name on Card ______________________________________________

Card Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Amount $_______ Expiry Date ____________ Signature ______________________________