Music Summit 2017 Registration Name* First Last Stage name* Date of birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Home phone*Cell phone*If your act includes more than one individual, please indicate the full name of each member, along with corresponding date of birth, phone number and email:Name of city and province you are currently based in:*Have you performed in any Talent Nation events in the past? If so, when and where?*YesNoWhen and where did you perform with us?*Where else have you performed? Also, please indicate any possible upcoming performances:*How did you initially find out about Talent Nation?*Artist / Band Website**write "none" if you don't currently have a websiteTwitter Handle**write "none" if you don't currently have a Twitter accountFacebook Fan Page**write "none" if you don't currently have a Facebook Fan PageInstagram Account**write "none" if you don't currently have an Instagram accountYouTube Channel**write "none" if you don't currently have a YouTube channelPlease include one video or music link that best demonstrates your skill*We will review your application in detail and get back to you within 7 - 14 days of submission. If you don’t hear from us by such time, please feel free to send a follow up email to firstname.lastname@example.org. Final verdicts will be sent to the same email address entered above, along with further details about the process.*If I am selected, I acknowledge that I am responsible for covering all meal, travel and accommodation expenses incurred during the event, as well as all activities leading up to the event.*I acknowledge that my personal information will not be divulged or shared with any third party and therefore agree to only receive updates from Talent Nation concerning information which is relevant This iframe contains the logic required to handle Ajax powered Gravity Forms.