Application Form for Individual Artist Registration

STAGE Society for Traditional Art’s Growth & Empowerment

Corporate office: #302, Albert Court, Albert Street, Behind Brigade Tower, Bangalore 560 025
Karnataka, India. TeleFax: +91 080 41494165; Call/SMS: +91 984433090
growth@stageindia.org www.stageindia.org

Registration Number (For Office Use)

STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE

Page 1 of 2
To Be Filled by the Applicant

Full Name
(English Block Letters) (Surname) (First Name) (Second/Middle Name)
PHOTO & SIGN
Gender Date Of Birth Father/Husband Name ON THE PHOTO

Name of Academy/Institution (Regd)

(If the artist belongs to any)

Address of Academy/Institution (Regd)

Artist Address for Correspondence

Pincode:

Artist Direct Contact Number E-Mail ID

Region to which the Artist Belongs How did you know about STAGE

Art Field Specialization (Check (√) whatever applicable)

Check Discipline of Art Sub -Specialization Gharana/Style
Vocal
Dance
Music (Instruments)
Sculpting
Painting
Theater

Guru(s) under whom trained (Give names and years of Training)

Period of Training Name of Guru(ji)

Major Performances/Achievements
(Give details such as occasion, festival, date etc.)

Scholarships/Accolades/Awards Received, if any

Signature of the Artist Date Place

Page 1 of 2
 Application Form for Individual Artist Registration
STAGE Society for Traditional Art’s Growth & Empowerment
Corporate office: #302, Albert Court, Albert Street, Behind Brigade Tower, Bangalore 560 025
Karnataka, India. TeleFax: +91 080 41494165; Call/SMS: +91 984433090
growth@stageindia.org www.stageindia.org

Registration Number (For Office Use)

STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE

Page 2 of 2
To Be Filled by the Applicant

Degree/Diploma/Certificate Obtained, if any

If engaged in imparting training/ teaching

(Give complete details)

Any recording/publications etc. / to your credit

(Give complete details, Please attach a copy of the same)

Any Additional Information:

Please maintain confidentiality of my personal contact information. I want only authorized STAGE employees to
contact me. (Please check if required)
Note:
1. All members should be in constant contact with the Head Office, so that the aims and objective along with the guide lines as laid down by STAGE
are timely achieved.
2. All Members to keep STAGE up to date with their past & future performing events.
3. The rules & regulations as laid down by the STAGE governing body can be collected from the Head Office.
4. Any member found guilty of misusing STAGE registration, will be expelled from STAGE and his/her registration shall stand canceled with immedi-
ate effect.

Mandatory Documents:
1. Photocopy of Address Proof (Signed by the Artist or the Academy Authority)
2. Photocopy of ID Proof (Accepted proofs are Driving License, PAN card, Voter’s ID card, Passport; Signed by the Artist or the Academy Authority)
3. Photographs attested by the individuals
4. Photocopies of Certificates received (Signed by the Artist or the Academy Authority)

By signing this application form below you are agreeing to the terms of service set by STAGE & agree to receive the STAGE
information, and occasional other related communications. (Terms of service document can be availed from STAGE website or STAGE Office)

Signature of the Artist Date Place

For Office Use Only STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE STAGE

Registration Number: Application Received Date:

Received & Checked By:

Any Comments:

Seal Director Member Services Executive Director

Page 2 of 2