Application Form
Event Timing: 26th October, 2019
Event Address: Elmwood Hall, Queens University, Belfast.
Contact us at +44 7727224095 or polerciseltd@gmail.com
Email address *
Full Name "Performer" *
Stage / Preferred Name at event – if applicable
Category *
If doubles, partners name.
Address *
If doubles, partners address.
Mobile number *
If doubles, partners mobile number.
Other Contact
Email *
If doubles, partners email.
Experience / Titles *
If doubles, partners experience / titles.
How long have you been pole dancing? *
If doubles, how long has partner been pole dancing?
Your Promotional Blurb *
Example: Where are you from? How long have you been pole dancing? What do you love most about pole dancing? What is your act about?
Link to your YouTube Video Entry *
I declare that I have read and understood the above mentioned competition rules and regulations *
Submit
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