Name: ____________________________________________________
(please print clearly or reproduce on a computer)
*Nationality: ________________________________________________
*Date of Birth: ______________________________________________
Address: __________________________________________________
(street and number)
City: ____________________________________________
Zip Code/Postal Code: _______________________________________
State/Country: ____________________________________________
E-mail address: _____________________________________________
Telephone Number: _________________________________________
(please include international calling code — we will not process your application without a telephone number where you can be reached)
Does your country of origin require a letter of invitation for your obtaining a Ukrainian Visa? ______ Yes ______ No
Please use this checklist to insure that all required elements are included with this application:
_____ Curriculum Vitae
_____ Performance Videotape (DVD or VHS Format)
_____ Recent Photo
_____ Biographical Sketch
_____ List of Repertoire Conducted
_____ $75 Non-refundable processing fee ((made payable to Vakhtang Jordania International Conducting Competition) — Please note — all checks must be written in U.S. Dollars
