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Hi there, please fill out and submit this form to apply for Kiama Songwriters Retreat.
21
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Name
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First Name
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Saint Lucia
Saint Martin
Saint Pierre and Miquelon
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Samoa
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eSwatini
Sweden
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Tokelau
Tonga
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Western Sahara
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Zambia
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Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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5
Mobile Phone Number
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6
Landline Phone Number
Area Code
Phone Number
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7
Date of Birth:
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8
What was your age at your last birthday?
*
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Age Verification : all successful applicants must be able to provide age verification if requested by retreat staff at anytime during the Kiama Coastal Songwriter's Retreat.
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9
If you're under 18 please enter your parent or guardian's details
Name
Phone
Email
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10
Please upload a recent photo of yourself
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11
Do you give permission for Kiama Songwriters Retreat to use your image on social media?
*
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YES
NO
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12
Tell us in a few words about your songwriting experience...
*
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e.g. How many songs have you written? Have you been to a songwriters workshop before?
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13
What category of songwriter are you?
*
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please chose one that most closely describes you...
Songwriter only (words and music) (I'm not comfortable performing my songs)
Songwriter only (words and music) (I would like to perform my songs but I’m not comfortable performing them yet)
Lyricist (words only)
Composer (music only)
Singer Songwriter Performer (I write lyrics and music and I’m confident performing my songs)
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14
Do you play an instrument ?
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YES
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15
If you do play an instrument/s tell us about what you play and what level you are.....
Instrument 1
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Beginner
Intermediate
Advanced
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Please Select
Beginner
Intermediate
Advanced
Level
Instrument 2
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Beginner
Intermediate
Advanced
Please Select
Please Select
Beginner
Intermediate
Advanced
Level
Instrument 3
Please Select
Beginner
Intermediate
Advanced
Please Select
Please Select
Beginner
Intermediate
Advanced
Level
Instrument 4
Please Select
Beginner
Intermediate
Advanced
Please Select
Please Select
Beginner
Intermediate
Advanced
Level
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16
Please upload an example of some lyrics you have written:
Please advise songwriter credits (if you're using a song you have co-written please include names of all songwriters involved)
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17
Upload your original song - MP3
Please upload a mp3 of your song here:
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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18
YouTube link
A video of yourself or someone else performing one of your originals
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19
Why do you want to attend Kiama Songwriters Retreat?
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20
Upload a video
A video of you playing an original or cover song
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Max. file size
: 10.6MB
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21
Should my application be successful, I grant permission for the event managers of Kiama Songwriters Retreat & professional photographers employed by them, to take photographs and/or footage of myself during the retreat to help promote events now and in the future.
*
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