IPY PHOTO AND VIDEO CONTEST ENTRY FORM (See rules below)

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AK Shorts Photography and Video Contest - PRINT THIS OUT

ENTRY FORM (page 1 of 2)

NAME _______________________________________________

ADDRESS _______________________________________________

_______________________________________________

_______________________________________________

E-MAIL _______________________________________________

PHONE NUMBER _______________________________________________

UA Student? [ ] Yes [ ] No

Banner ID Number (UA Students only) _______________________________


Category (please circle) Photo Video

Theme (please check one)

[ ] My Life in the North

[ ] Experiencing the Wild

[ ] Discovering the Arctic

[ ] Alaska’s Inconvenient Truths

Photo Caption (less than 100 words):


¬¬¬¬¬¬ AK Shorts Photography and Video Contest - ENTRY FORM (page 2 of 2)

Ownership Verification Statement:

I, _______________________________, acknowledge that I am the sole owner of the photo / video (circle one) that I am submitted to this contest.

Signature ________________________________________Date___________________


Release Statement:

Upon submitting my photo / video (circle one), I grant to the University the right to use, publish, adapt, assign, edit, dispose of, and/or modify my video or photo in any and all ways and in all media whether now known or later developed, worldwide, in perpetuity, without limitation or approval by or compensation to me or any or all members of my team and agree to sign a release to this effect when and if requested to do so by the University. Entry submission constitutes my consent and the consent of all members of my team to irrevocably assign and transfer to the University, in perpetuity and without any fee or compensation any and all right, title interest and claim, including but not limited to, all intellectual property, sales, and licensing rights which I had, may have or will have to the video and the concepts embodied in the video.

Signature ____________________________________Date___________________

Release Signatures for individuals portrayed or represented in the photo or video (see section 6 in the Official Rules):

Name (Print) _____________________________________________ Signature ______________________________________________ Date _______________

Please provide additional names and signatures on a separate sheet if necessary.

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