Contestant Application Form - The I.B.M. Close-Up Contest 2012

The I.B.M. Close-Up Contest Application
The Gold Cups International Award of Excellence

Applicant's Full Name: *

Stage Name (if any):

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 or older)

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

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

Yes

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.

NOTE: No Pyrotechnics of any type may be used in the I.B.M. Gold Cups 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 reset your act between performances?: *

Once your set is complete, do you leave items on the floor which will require attention (confetti, cards, water, etc)?: *

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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