The 46Th Annual Japanese Language Speech Contest

APPLICATION FORM

THE 46TH ANNUAL JAPANESE LANGUAGE SPEECH CONTEST

VICTORIAN STATE FINAL 2015

Organised by:

The Japanese Language Speech Contest Victoria, Inc. (Reg. No. A0053233K);

Consulate-General of Japan in Melbourne; and

The University of Melbourne

Please read the Contest Guide before completing this form.

How to apply: Please refer to the Contest Guide – 3.1.2.

Please save your completed Application Form in Word and attach it to your application email.

If you do not receive a confirmation email after submitting your application, please contactby email or telephone:

Ms Kumiko Toyama

Information and Culture Section

Consulate-General of Japan in Melbourne

E-mail:

Telephone: 03-9667-7824

Your Division - Please tick ✔the Division you would like to apply for.

HIGH SCHOOL SENIOR;

OPEN BEGINNER; OPEN; BACKGROUND SPEAKER

About yourself

Your name in English / Mr / Ms / Surname: / First name:
Your name in Katakana / Surname: / First name:
D.O.B. dd / mm / yy / AGE: / Nationality: / First language:
Language/s spoken at home: / Other language/s spoken:
Home address: / Postcode
Phone: / Mobile: / Fax:
E-mail: / Occupation:
If you are a student / Year Level
School/Institution name
Phone: / Fax: / Teacher’s e-mail:
Your speech title in English:
Your speech title in Japanese:
Have you participated in a speech contest before?
Yes / No / If yes, when?

CONTINUED TO NEXT PAGE

Japanese learning history

When? / How many hours? / Where?
High School
University, TAFE or Language School
Private lessons
Total

In-Japan experience – If you have been to/lived in Japan

When / How long? / What did you do in Japan?

Applicant's Declaration:

I have read the Contest Guide.

I agree / disagree to abide by the conditions of the competition and accept the decisions of the judges as final on all matters relating to the contest.

By participating in the speech contest, I consent to all its terms and conditions including the taking of photos and the audio/video taping of my speech (if applicable).

I acknowledge that as the owner of the copyright of the photos and videotapes, the JLSCV Inc. Committee may make the videotapes, containing footage of my speech, available to the general public. I also acknowledge that photographs taken may be used in publications.

Name:

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