| NUME SI PRENUME CONCURENT (Name):* |
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| DATA NASTERII (Birthdate):* |
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| ADRESA (Home address):* |
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| E-MAIL:* |
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| TELEFON (Phone):* |
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| PROFESOR COORDONATOR (Music teacher):* |
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| PALMARES (Awards):* |
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| PIESA INSCRISA IN CONCURS (Song to be submitted):* |
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| COMPOZITOR/TEXTIER (Composer/lyricist):* |
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| SEMNATURA (Signature):* |
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