Signature: Callista Kosasih 20/10/20 Performer/Ensemble Director’s Signature Date
Please note that a parent/guardian/teacher may sign on behalf of performers aged 16 and under.
Please complete all applicable sections.
1. Performer’s Declaration I certify that I will be performing (tick one):
✔ From an original published edition of the sheet music;
From a photocopy, transcription or arrangement of sheet music that is accompanied by a letter from the music publisher authorising the use of this photocopy, transcription or arrangement (attached to this form); From sheet music where both the work and edition are out of copyright*; or By ear.
2. Making a temporary copy for an adjudicator or examiner (tick only if applicable)
✔ I certify that I have made a copy of the legal sheet music from which I will perform for use by an adjudicator or
examiner.
I acknowledge that this copy will not be returned to me and will be destroyed by the eisteddfod/competition organisers and I must delete any digital copy of this sheet music I have made.**
3. Making a temporary copy for an accompanist (tick only if applicable)
I certify that I have made a copy of the legal sheet music from which I will perform for the use of an accompanist.
I acknowledge that this copy will be returned to me and I must destroy it immediately, and I must delete any digital copy of this sheet music I have made.**
4. Copies made by an auditioning body for BAND and ORCHESTRA only (tick only if applicable)
I certify that I am performing from copies made by an auditioning body for my use in this competition only.
I acknowledge that I must return these copies to the auditioning body at the end of this section and they will be destroyed by the eisteddfod/competition organisers.** 2
5. Musical works Please include information on the works you will be performing. Write additional works information on the back of this form.
Work Title Composer/Lyricist/Arranger Publisher
Cha-Cha-Cha Gerard Hengeveld Hal Leonard
Do not return this form to APRA AMCOS.
It must be provided to the event organisers only. * Composer/lyricist/arranger ALL died before 1955 and the edition publication date was more than 25 years ago.
** Any use of copies made under this declaration outside of the performance in this specific eisteddfod/competition/examination is deemed an infringement. All copies – both digital and hardcopy – must be destroyed.
