Contestant Application Form - The I.B.M. Stage Contest 2012

The I.B.M. Stage Contest Application
The Gold Medal International Award of Excellence

Stage Name (if any):

Applicant's Full Name: *

Street Address: *

City: *

State: *

Postal Code: *

Country: *

Telephone Number: *

Email Address: *

I.B.M. Membership Number: *

City/I.B.M. Ring(s) to which you belong:

Date of Birth: *

Select one: *

Adult (18 and older)

Youth (7 to 17, signature of legal guardian will be required)

Are your dues paid in full through July 2012?: *

Yes

NOTE: No Pyrotechnics of any type may be used in the I.B.M. Gold Medal Contest Acts. This includes flash paper, any open flame,: *

I will not use pyrotechnics in my act.

How long (in minutes) will it take for you to move your act from the wings and set your act on the stage?: *

Please keep in mind that each competitor will have 2 minutes to set props on the stage, 8 minutes to perform, and 1 minute to strike or remove items from the stage. This includes confetti, streamers, cards, props and anything belonging to the performer. We suggest that in the event the competitor is using any the above mentioned items, he/she use a drop cloth on which to perform. This will expedite the clean up and enable the competitor to clear the stage within the 1 minute allotted.

Please send a headshot (photograph), DVD, Windows Media File, or VHS of your performance via email or post. This recording will be used to prepare adequate technical support for your competition experience.

Agreement: *

I certify that the foregoing information is true and correct, that I have read and agree to abide by the Contest Rules and Procedures, and that no knowingly unauthorized use of intellectual property will be included in my contest performances. I agree to indemnify and hold the International Brotherhood of Magicians harmless for any damages, expenses or losses it may incur by reason of claims made against me as a result of my participation in this contest, regardless of the merit of any such claims. I agree to be bound by all decisions of the Contest Judges. I agree that any untrue statements made by me or a breach by me of any covenants contained herein shall be grounds for disqualification.

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