Adult Mixed Instrument ConcertinaPiano AccordionAmhránaíochtFiddleRince ar an Sean Nós

BanjoFluteUilleann PipesBodhránFoundation Course * Traditional Singing

Button AccordionHarpWhistle ComhráPiano Accompaniment

* Foundation Course is o�ered to students 12 to 18 years with an intellectual disability.

Beginner(Singing/Dancing only)

Improver Fairly Competent

Competent Advanced

International applicants please provide local phone N°

CLASS CHOICE (tick 1 choice only)

LEVEL (tick 1 only. Guideline only, all students will be graded)

Ainm (Name) ____________________________________________________________________BLOCK CAPITALS - �is name detail will appear on your badge

Seoladh (Address) ________________________________________________________________

_______________________________________________________________________________

Fón (Phone N°) _________________________ Dáta breithe/Date of birth ____________________

A PHONE NUMBER IS REQUIRED FOR ALL STUDENTS UNDER 18 YEARS

Parent / Guardian Name & Mobile N°__________________________________________________

________________________________________________________________________________

Seoladh r-phoist (E-mail) __________________________________________________________Email addresses must be active and spelled very clearly. �is email address will be stored and used to contact you in relation to Scoil Éigse and Comhaltas, unless you have asked us not to do so.

REGISTRATION FEES (tick 1 only)

Note: Scholarship students cannot be included as part of family member reductions in relation to fees.

Card Number

Expiry Date: Month ___________ Year ___________ CVV2

TOTAL AMOUNT DUE € __________________

Cardholder’s Name: ________________________________________________________________

Contact Number:___________________________________________________________________

Pre-registration closes at Midday 29th July. No applications will be accepted at Head Office after this deadline. This is to facilitate essential administration. All other applications will be considered onsite

in Mullingar on a first come basis and are strictly subject to availability

LATE FEE(applies from July 18th to noon July 29th)

First Family member

Second Family member

Additional Family member

€135

€120

€110

First Family member

Second Family member

Additional Family member

€150

€135

€120

EARLY FEE(applies until July 17th)

Completed forms and fees should be sent to:Comhaltas Ceoltóirí Éireann, 32 Belgrave Square, Monkstown, Co. Dublin A94 XV02

email: liza@comhaltas.ie

IMPORTANT- Comhaltas may reproduce photos, video footage, images etc. of you, either individuallyor as part of a group and may also assign reproduction and other rights of these to a third party.

Please indicate by ticking here if you prefer NOT to allow copyright for publications.

Signature: ______________________________ Date: ______________________________________

Where students are under 18 years, this should be signed by a parent or guardian

PAYMENT (BLOCK CAPITALS PLEASE)

Accepted payment: Euro Cheque, Bankers Euro Draft, Visa and MasterCard debit/ credit cards. Euro Cheques and Drafts should be made payable to Comhaltas Ceoltóirí Éireann.

MEDICAL/ACCESSIBILITY DECLARATION:Please inform the Scoil Éigse Information Centre/Comhaltas Head-O�ce in writing of any medical condition

or accessibility issue associated with this application that Scoil Éigse should be aware of.Note: It is the responsibility of the parent/guardian or applicant to provide further details as

necessary with the application form.