Photograph - Entry Form - Mladiinfo

helmetpastoralΛογισμικό & κατασκευή λογ/κού

13 Δεκ 2013 (πριν από 3 χρόνια και 9 μήνες)

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Page
1


PHOTOGRAPH

CATEGORY:

SNAP
-

PHOTOS (Catching Time)

Competition Entry Form



Please tick


the b潸 tha琠applie猠below:

The
photograph

is submitted by:



Individual student



Group of students
(
Number of students in group: ____
)



Please tick


the bo
x tha琠applie猠below
:

At the time of submitting the entry I

am
/we are attending:



Secondary Education (Post
-
Primary)




Further Education



Higher Education



Other (Please state type of Education)
: ___________
________________
______________



Details:

In the case of a group entry
,

please
include

below the name and details of the person

representing the group. In the for
m (found on the last page), the
details of
all

members of
the group should be listed.



First Name: _________
__
_______
__
_______
______
Surn
ame:
_____
_______
____________


Address/City/Post Code/C
ountry: ________
__________
_________________
_____________


Email addres
s: ____________
_________
______ Telephone Number: __
_
___
_______
_
_____


Skype address (if available): __
________
_________________
____________
____
_________


Role if representing a group (e.g. teacher, studen
t member of group etc.):


______________________________________________
___________________
__________




Page
2


Institution/School Details:



Name:
_____
_________
__________
______________________________________________


Address/City/Post Code/Country: _____________
_________________
_____________
___
__



Details about the

Photograph
:


P
hotograph

caption
:

________________________
____
_________________
_____________



Dat
e when photograph was
taken
:
__________
_____________
________________
________



Details of lo
cation where photograph was taken
: _____________
______________
________


_
________________________
______________________
___________________
_________



Short descript
ion of the photograph and how
it is

link
ed

to sustainable/responsible living
and the competition brief/theme (150 words maximum):







If this is a group entry please describe the role of each group member

(
50 words maximum)
:









Page
3


Please tick


the b潸e
s bel潷:

Has

written permission
been
sought from
individual
s appearing in the photograph

(parents
in the case of children) to have the photograph
:




entered for th
e PERL

competition

and



used by
PERL and its
partners
for promotional and/or educational purpos
es in the
promotion of sustainable and

responsible living




YES and a copy of the written permission(s) are on file and can be made available to

PERL if requested





NO (Please explain)

________
______
________________
_______________________


___________
________________________________
_________________
_________




Please tick


the b潸es bel潷:





I/we
certify that this
photograph
is my/
our
own
original
work
,

has not been


previously published and
is not in bre
a
ch of any copyright rules or regulations





I/we certify that the photograph
does not include branding, promotion of labels or

hidden advertising





I/
we
perm
it PERL and its partners to use/reproduce
th
is

photograph

for
promotional

and/or

educational purposes in the promotion of su
s
tainable
/
res
ponsible living






I/
we have read and
accept the rules of the competition

found
at


http://www.perlprojects.org/





Signature
:






Date:





Page
4


Don

t forget
:



Scan the signed
entry
form and
email

the form
(in PDF
)
with the photograph
(in the
required format)
to
:
perlmedia2013@gmail.com

Ensure that the entry form and
p
hotograph are sent together
as attachments
in the same email



Include the following title in the subj
ect li
ne of the email when sending: ’
Photograph
Compet
ition
PERL 2013’.



Competition

closes at
midnight
1
3
th
December

2013

(Central European Time)




Page
5


Group Entries



I
n the case of a group entry
all

member
s

of the group
must

complete and sign the
form

below



By signing below you are
certify
ing

that thi
s
photograph

is
your
own
original
work and
you are
permit
ting

PERL and its partners to use
it
for promotional and/or educational
purposes in the promotion of su
s
tainable/
responsible living



.1

.2

.3

FIRST NAME




SURNAME




DATE OF BIRTH




EMAIL ADDRESS




At the time of
submitting the entry I
am attending:








NOTE
: State which
applies to you.



Secondary


Education


(Post
-

Primary)




Further Education




Higher Education




Other
(Please state t
ype of
Education)


____________________




Secondary


Education


(Post
-

Primary)




Further Education




Higher Education




Other
(Please state type of
Education)


____________________




Secondary


Education


(Post
-

Primary)




Further Educat
ion




Higher Education




Other
(Please state type of
Education)


____________________

I have read and I
accept the rules of the
competition.

SIGNATURE

(of

each
member of group)