Skip to main content
The Pink Jukebox Trophy 2021 Entry Application
Page
1
There was an error on your page. Please correct any required fields and submit again.
Go to the first error
*
Names
Required
- Required.
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.
Required
- Required.
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
Required
- Required.
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)
Required
This is required
*
Level for each category entered (Introductory, Intermediate or Advanced)
eg Solo Ballroom Introductory
Required
- Required.
*
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.
Required
- Required.
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