2021 J.D. Kelly Competitions (Piano)

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Upon submission of this form, you will receive a PayPal invoice to the email address you provided (please allow two business days). Please note that your application is not complete until your payment has been received.

Participant's last name/ family name/surname *

Participant's first name *

Participant's age/grade (or year in college) *

Parent/Guardian name(s) for students in grades 1-12 *

Participant's Email Address *

Phone number (if parent, please specify which parent) *

Mailing address (street/city/state/zip) *

Name of the teacher, last name/first name *

Phone number of the teacher *

Email address of the teacher *

Are you exempt from the video round? If yes, please put "N/A" for the following four questions. *

Yes

Repertoire 1 - YouTube Link (please make sure that it is an "Unlisted" video) *

Repertoire 1 - Composer, Title, and Length (minutes/seconds), *

Repertoire 2 - YouTube Link (please make sure that it is an "Unlisted" video) *

Repertoire 2 - Composer, Title, and Length (minutes/seconds), *

Scales, Arpeggios, Cadence/Chord 1 (YouTube Link and Key) *

Scales, Arpeggios, Cadence/Chord 2 (YouTube Link and Key) *

Would you like to participate in any of the following? *

In-person master class with Dr. J. D. Kelly or Dr. Lauren Schack Clark on Oct. 31 or Nov. 7, 2021 (additional $10 will be applied to the invoice)

An online 30-minute online lesson with piano faculty members at Arkansas State University (additional $20 will be applied to the invoice)

Photography Release for Minor Child or Children (VOLUNTARY) - I hereby authorize the A-State J. D. Kelly Competition to publish photographs taken from video submissions of myself and/or the minor child or children listed above, and our names and likenesses, for use in the A-State J. D. Kelly Competition print, online and video-based marketing materials, as well as other publications.I hereby release and hold harmless A-State J. D. Kelly Competition from any reasonable expectation of privacy or confidentiality for myself and for the minor child and children listed above associated with the images specified above. Further, I attest that I am the parent or legal guardian of the child or children listed below and that I have full authority to consent and authorize A-State J. D. Kelly Competition to use their likenesses and names.I further acknowledge that participation is voluntary and that neither I, the minor child, nor minor children will receive financial compensation of any type associated with the taking or publication of these photographs or participation in A-State J. D. Kelly Competition marketing materials or other A-State J. D. Kelly Competition publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever.I hereby release A-State J. D. Kelly Competition, its contractors, its employees and any third parties involved in the creation or publication of A-State J. D. Kelly Competition publications, from liability for any claims by me or any third party in connection with my participation or the participation of the minor children listed above.

I agree

I DO NOT agree

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