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Bill Riley Talent Show Registration
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* Indicates required question
Name
*
First and Last name
Your answer
Age
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Division
*
Sprout (age 2-12)
Senior (age 13-21)
Type of Talent
*
Vocal
Dance
Piano
Other:
Type of Dance (if applicable)
Your answer
Is a Keyboard Needed? (if applicable)
Yes
No
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Song Name
*
Your answer
Street Address
*
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Town
*
Your answer
Zip Code
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
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