Fiche Ins. ENGL Mehura 2015

‘ORI TAHITI NUI MEHURA COMPETITION - 2015
MERIDIEN TAHITI, 28 novembre 2015
Fiche d’Inscription MEHURA
Contact: tumata.robinson@mail.pf or manouche@mail.pf

To participate in the Mehura contest, the 5 artistes of each formation have to be a minimum of 16 years
old. The Mehura contest will be held on Saturday November 28th at the Meridien Hotel.
Registration will be from 1h00 pm to 2h00 pm and the competition will star tat 2h30 pm.
Person in charge and artist n°1
Name:____________________________________
Surname:__________________________________

Name of Formation:
__________________________________________
___________________________________________
Group or dance school reference:

Adresse:

___________________________________________
E mail:

Telephone:

___________________________________________

___________________________________________

Engagement:
Waiver (All participants required to sign below):
I hereby agree to respect and abide to all the rules instituted by ‘ORI TAHITI NUI’ for the 4th 'ORI TAHITI NUI
MEHURA COMPETITION – 2015 scheduled on the Island of Tahiti Saturday November 28th. I agree not to hold
‘ORI TAHITI NUI’ responsible for any loss or damage caused to my personal property, or for any bodily harm
or injury occurred during this event. I will be responsible for any/all expenses caused by injuries to staff or
degradation arising as a result of my negligence or willful misconduct of services and facilities of the Hotel
hosting the event. Finally I give exclusive rights to ' ORI TAHITI NUI to use any photos or videos taken during
the event for promotional use.
In witness of my agreement to the terms above, I affix my signatures

Signature of the person in charge:____________________________________Date :________________
10.000 F CFP

‘ORI TAHITI NUI présente

Payé en espèces le
Payé par chèque bancaire B

Chant :
______________________________

_________________________________

_______________________________

‘ORI TAHITI NUI MEHURA COMPETITION 2015 – Fiche d’Inscription MEHURA

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Engagement of other 4 Mehura artistes:
I hereby agree to respect and abide to all the rules instituted by ‘ORI TAHITI NUI’ for the 4th 'ORI TAHITI NUI
MEHURA COMPETITION – 2015 scheduled on the Island of Tahiti Saturday November 28th. I agree not to hold
‘ORI TAHITI NUI’ responsible for any loss or damage caused to my personal property, or for any bodily harm
or injury occurred during this event. I will be responsible for any/all expenses caused by injuries to staff or
degradation arising as a result of my negligence or willful misconduct of services and facilities of the Hotel
hosting the event. Finally I give exclusive rights to ' ORI TAHITI NUI to use any photos or videos taken during
the event for promotional use.
Artiste n° 2
Name:______________________________________
Surname:____________________________________

Date of Birth:___________________________
Telephone:_________________________________

In witness of my agreement to the terms above, I affix my signatures

Artiste n° 3
Name:______________________________________

Date of birth:___________________________

Surname:____________________________________ Telephone:_________________________________
In witness of my agreement to the terms above, I affix my signatures

Artiste n° 4
Name:______________________________________

Date of Birth:___________________________

Surname:___________________________________

Telephone:________________________________

In witness of my agreement to the terms above, I affix my signatures

Artiste n° 5
Name:______________________________________

Date

of birth:___________________________

Surname:___________________________________

Telephone:________________________________

In witness of my agreement to the terms above, I affix my signatures

‘ORI TAHITI NUI présente

‘ORI TAHITI NUI MEHURA COMPETITION 2015 – Fiche d’Inscription MEHURA

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