APPLICATION FORM
The questionnaire must be completed as part of the submission process. A printed copy must be submitted if a DVD is sent via mail. If mailing in your submission, please follow the submission guidelines outlined here (click here). Oticon and AAA Foundation reserve the right to select semi-finalists for the competition. Decision of judges in the March 29 showcase is final. All videos submitted and tape and/or photographs from live performance become the property of Oticon, Inc. and AAA Foundation and can be used for marketing, promotion and other types of PR.
Act or group must be attending AudiologyNOW! 2012 or be willing to travel to Boston for the talent showcase on Thursday, March 29 at own expense.
All entries must be uploaded or postmarked by March 1, 2012.
If you are selected as a semi-finalist, your video submission will be posted on an Oticon and/or AAA Foundation website. Please send only video that you own and/or that you have permission of the owner to use for this purpose.
| Name* |
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| AAA/SAA membership number* |
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| Street Address* |
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| City* |
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| State* |
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| Zip* |
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| Home Phone* |
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| Cell Phone* |
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| Are age 18 or over?* |
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Yes
No |
| Email* |
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| If you are a student, please list school and expected year of graduation |
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| Stage name or group name (if applicable) |
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| Number of people in your act* |
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| Please briefly describe your talent* |
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| Does your video contain a song under copyright? If so, please list the title and artist of the song(s) you will be singing and/or performing to |
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Indicate your designated charity or non-profit cause*
(Oticon will donate $1,000 if you are chosen as the winner of this contest. You may designate any non-profit charitable organization or academic program of your choice.) |
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Upload Video:*
(Accepted file types are: asf, asx, avi, divx, dv, dvx, m4v, mov, mp4, mpeg, mpg, wmv) |
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