The Pink Jukebox Trophy 2021 Entry Application

Names *

Entrant's Name:

Preferred Method of Contact

Please be sure to provide contact details that correspond with your preferred method of contact. It is not necessary to provide other types of contact details. *

Email
Text Message

Telephone Call
Post (Mail)

Email Information

Contact Email 1:
Contact Email 2:

Telephone Information

Phone Number 1:
Phone Number 2:

Mailing Information

Street Address:
City:
Post Code:
Country:

Special Needs

Intended Competition Categories *

I intend to compete in the Men's Ballroom Couples competition
I intend to compete in the Women's Ballroom Couples competition
I intend to compete in the Men's Latin Couples competition
I intend to compete in the Women's Latin Couples competition
I intend to compete in the Solo Ballroom competition
I intend to compete in the Solo Latin competition

Name(s) of partner(s)

Level for each category entered (Introductory, Intermediate or Advanced)
eg Solo Ballroom Introductory *

Privacy consent
I understand that by submitting the films, I give permission to use excerpts for promotional purposes; and to broadcast them during the prize-giving event via Zoom. *

I/we consent to the publication of my/our name(s) and country on the website
I/we do not consent to the publication of my/our details

Country or countries represented
Please identify the country or countries that you are representing

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