| Title (eg. Mr, Mrs, Ms, Dr) : * |
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| First Name: * |
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| Surname: * |
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Please note that your full address will NOT be displayed on your listing (only Suburb,State and Postcode).
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| Address line 1: * |
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| Address line 2: |
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| Residential Suburb/Town: * |
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| Residential State: * |
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| Residential Postcode: * |
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| Contact Number: * |
(please don't leave spaces or use brackets)
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| Alternate contact number: |
(please don't leave spaces or use brackets)
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| Email Address: * |
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| Qualifications/Industry Memberships or Affiliations (50 character max): |
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| Where are you available to adjudicate (please select): * |
Anywhere in Australia
ACT
NSW - Sydney
NSW - outside Sydney
Vic - Melbourne
Vic - outside Melbourne
Qld - Brisbane
Qld - outside Brisbane
SA - Adelaide
SA - outside Adelaide
WA - Perth
WA - outside Perth
NT
Tas
International
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| I can adjudicate these types of Eisteddfods: * |
dance
instrumental
speech & drama
vocal
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| Overview of yourself to appear on your listing (500 character max): * |
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| Would you like to attach a photo of yourself to your listing? * |
Yes (I will email a file with my photo)
No
Post (I will send a photo in the mail to be added to my listing)
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| Would you like to attach a resume? * |
Yes (I will email a file with my resume)
No
Post (I will send a copy of my resume in the mail)
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| Notes or comments to eDance Admin (250 character max) (Will NOT be displayed on your listing. For eDance use only) |
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| Discount coupon code: (if applicable) |
(case sensitive) |
