Name: …………………………………………………………………..…………………......................

1. X’MAS FACTOR 21ST NOVEMBER - LIVE TALENT SHOW Registration Form Affix one Passport size photo Name: …………………………………………………………………..…………………...................... Address: ……..…………………………….………………………………………………………….... …….……………………………………………………………..……….….......................................... Email: ………..………………….………..……….. Mobile……………..……..……........................ Age: ………..… Male/Female ………..……... Telephone: ……………..…...... ………………. Tell us about your act: …………………………………………………………………………………. …………………………………………………………………………………………….……………… …………………………………………………………………………………………………………... If musical accompaniment is required, are you supplying this on mini-disc or CD? MD/CD Please note: judge’s decision will be final. If under 16, parental consent is required Signed ………………………………………. Entrant or Parent / Guardian. Date:………….… Disclaimer: the organizers of this competition reserve the right to use your image for marketing purposes. All personal information will be held in accordance with the Data Protection Act, and will not be passed to any third parties without your prior permission. Please note photo’s and CD’s mini- discs should be collected after your performance. If left, we cannot guarantee return. Successful participants receiving majority ‘yes’ vote, will be given an automatic entry in the May 2010 Ashford’s Got Talent Show (exact date to be confirmed) Entries to be submitted to ATCP, 2nd Floor, Ashford House, County Square, Ashford, by 16th November 2009 Another great event from… Ashford’s Got Talent 2010 will be sponsored by …