MINISTRY OF ARTS AND CULTURAL HERITAGE - Registration Form

MINISTRY OF ARTS AND CULTURAL HERITAGE

7^th Floor, Renganaden Seeneevassen Building

Cnr Pope Hennessy & Maillard Streets,

Port Louis, Republic of Mauritius

Telephone: 212 2112 | Fax: 211 0681

Email: macdoc@govmu.org | Website: https://culture.govmu.org

REGISTRATION FORM

OBJECTIVE: To compile a Database of Mauritian Artists, Creators and Performers

* are mandatory fields and need to be filled

A: General Information

Title (Mr. / Mrs. / Miss)*

Surname *

Other Name *

Name of Group *

ID no. *

Address for all correspondence *

Present Occupation*

Telephone Residence

Telephone Place of Work

Mobile*

Fax

Email *

B: Discipline (Tick as appropriate)

Music

Cinema

Dance

Literature

Visual Arts

Architecture

Theatre

Others

For Others, Please provide details:

C: Area of Specialisation (*)

Give brief statement of the area of specialization within discipline (Example: classical or modern music/dance, painting, photography, sculture, etc) *

D: Qualifications

Qualification 1

___________________________________

Qualification 2

___________________________________

Qualification 3

___________________________________

Qualification 4

E: Details

Do you provide training to others in your field of activity? If yes, please give details

Do you perform / exhibit in:

Solo

Duo

Group

Please submit a list of your creations / productions:

SN	Creation / Production
1
2
3
4
5

Please attach additional information if required:

F: International Participation

Please list the international events in which you have participated:

SN	Event	Country	Year
1
2
3
4
5

G: Registration

Are registered with the Mauritius Society of Authors (MASA)?

Yes

No

If yes, please provide Registration No.

Are you registered with any other Local or International institution / body? Please specify:

SN	Institution / Body registered with	Year of Registration	Other details
1
2
3
4
5

H: Any other relevant information

I: Referees

Referee 1

Referee 2

J: Attachments (Each attachment must not exceed 1.5 MB and be of type pdf)

Identity Card of Applicant *

Identity Card of Group Members (if applicable)

BRN in respect of the Group (if applicable)

Documentary Evidence such as press cuttings, testimonials, projects / porfolios, photos in the field applied / specialized

Additional Information

K: Group Members

Surname	Other Name	Address	Phone No.	Function Specialisation

L: Commitment

* I agree that the Ministry publishes / communicates the following information, name, address and telephone number for professional purposes, in the Directory of Artists.

* I certify, in good faith, that the information provided on this form is accurate.

Date: