Application Form

Piano Duo

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Contestant #1
Birth Date
Citizenship
Contestant #2
Birth Date
Citizenship
Music SchoolUniversity
Current Teacher
Telephone
For USD Transfer
Beneficiary Bank: JSC TBC Bank, Tbilisi, Georgia, SWIFT: TBCBGE22
Ben’s IBAN: GE27TB7066136180100005
Name of Beneficiary: LTD "Classical Music Development Fund"
Intermediary Bank: Citibank N.A. New York, USA, SWIFT: CITIUS33, ABA: 021000089
Intermediary Bank: Deutsche Bank Trust Company Americas, New York, USA, ABA: 02001033
Program
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Education Background of Applicant
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Previous Prizes and Awards
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Required Documents: a) Online Application b) Color Photo c) Copy of Passport d) Copy of Payment Receipt
Name of Guardian

Name of guardian is required if applicant is under 18 years old!

Waiver and Release Agreement

According to this Waiver and Release Agreement (hereinafter referred to as “Agreement”), I hereby acknowledge and agree that: a) in order to be allowed toparticipate in the T. Amirejibi Borjomi International Piano Competition (hereinafter referred to as “Competition”), I give up my rights to hold the organizers, managers, their employees and jury members liable for any injury that I may suffer while participating in the Competition; b) by signing this agreement, I am assuming full responsibility for all risk while participating in the Competition. I am committed to follow the instructions and rules set by the organizers, and I will not withdraw at any time from the Competition without the consent of the organizers. I agree to allow the organizers to use my biography, my photos and video footages during the entire competition for promotional and commercial purposes. I promise to provide correct information about myself. I hereby declare that I am the contestant. I have read this agreement, understand it and agree to be bound to it as a contract (Signature of guardian is required if applicant is under 18 years old).
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