This form is not for Sale and can be Reproduced

REGISTRATION FORM (MUSEAKA/MTV-MAKING COMPETITION) Instructions: Individual participants can directly fill out this form. For group participants, kindly identify the leader to fill out this form. As for the rest of the members of the group, the names can be written at the back of the registration form. In case of group winners, the team leader shall represent the group to receive the award during the Awarding Ceremony in Quezon City.

Last Name

First Name

Middle Name

Complete Home Address

E-Mail Address

Contact Number(s)

Date of Birth

Name of School

Address of School

Year Level and Section

Adviser's Name

Title of the Music Video

Brief Description of the Music Video

I attest that the information above are true and correct, and that any false information written above can be used as grounds for my disqualification from the contest. __________________________________ Contestant's Signature over Printed Name __________________________________ Date Signed __________________________________ Adviser's Signature over Printed Name __________________________________ Date Signed