First Name *

Last Name *

Home Address

Post Code

Postal Address (if different to above)

Home Phone

Mobile

Email Address *

Date Of Birth ...

Medical Conditions

1. Name

1. Phone

1. Mobile

2. Name

2. Phone

2. Mobile

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Why do you want to be a part of the Senior Actors Ensemble?

What skills/projects/areas of performance are you interested to develop/expore?

How will a year of Ensemble training help you as an Emerging Artist?

Please outline your current commitments (University, School, Work etc)

Please list any shows, events, relevant classes or training

I agree that I am available for the periods listed in these pages and I agree to fully commit to the Rehearsal Schedule outlined if I am selected to join the 2012 Ensemble. Yes No

I grant permission to Canberra Youth Theatre to use still and moving images of me for the purposes of use in any CYT publication (all media, including web), exhibitions and CYT marketing and publicity Yes No