I n s t i t u i a P u b l i c Na i o n a l a A u d i o v i z u a l u l u i

Registration Application
for the Pre-selection Contest for representation of the Republic of Moldova at the
Eurovision Song International Contest 2015 Vienna, Austria!
Rel"ing on the infor#ation received $Enclosure 1% b" filling in this &pplication 'e confir#
registration at the Eurovision Song Pre-selection Contest 2015 $Republic of Moldova%( 'e
have fa#iliarised ourselves 'ith the Rules on Pre-selection Contest conditions and agree
'ith the pre#ises thereof!
)a#e of the co#position*
Perfor#er $surna#e and signature% +
Music #a,er $surna#e and signature% +
-"ricist $surna#e and signature% +
&rranger $surna#e and signature% +
.ate of application sub#ission
Perfor#er/s personal data*


Music #a,er/s personal data*


-"ricist/s personal data*


&rranger/s personal data*


0elephone*
TRM Contact details:
64 Hancesti Road, Chisinau, MD-2028
Telephone: +373 22 73470! "a#: $+373$ 22 72 3% 37
&-'ail: eu(o)ision*t('+'d
,,,+t('+'d
I n s t i t u i a P u b l i c Na i o n a l a A u d i o v i z u a l u l u i
E-#ail*
Subsemnata, Balaban Natalia, traductor autorizat n limba
englez, certifc exactitatea traducerii cu textul nscrisului n
original, care a fost vizat de mine la 24.10.2014.
I, the undersigner Balaban Natalia, the authorized translator of the
English language, certify the fdelity of translation of the original text, which
has been signed by me on 24.10.2014.
TRM Contact details:
64 Hancesti Road, Chisinau, MD-2028
Telephone: +373 22 73470! "a#: $+373$ 22 72 3% 37
&-'ail: eu(o)ision*t('+'d
,,,+t('+'d