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•• Entry/Release
Form
There are
two fomrs on this page that need to be filled out and submitted
with your entry. Print and you will have them.
Name:_____________________
Age:_____
Male: _____
Female: _____
School: ___________
School Address:
____________________________
Home Address: _____________________________
City: _______
State: _______ Zip Code: ___________
School Phone
No: ___________ Fax:__________ Home Phone No: ________
Title of Submission:
____________________ One entry per participant.
I hereby grant
and assign to the iam2m 40th Annual NCCJ Literature &
Arts Program Contest (iam2m Literature & Arts
Contest) the non-exclusive right and permission, in respect
of the original writing and/or artwork that I have submitted to
the iam2m Literature & Arts Contest, to
use, re-use, publish, and re-publish, and otherwise reproduce,
and display the same, or any portion of, individually or in conjunction
with other writing and/or artwork in any and all media now or
hereafter known throughout the world, for illustration, promotion,
art, advertising, and trade, or any other purpose whatsoever;
and to use my name to identify the author of the work in connection
with my participation in the iam2m Literature &
Arts Contest. I understand that any use of my work will include
my name as its creator. I hereby release and discharge the iam2m
Literature & Arts Contest from any and all claims
and demands arising out of or in connection with the use of the
original writing including without limitation any and all claims
for copyright infringement, libel or invasion of privacy.
The iam2m
Literature & Arts Contest may sell, assign, license,
or otherwise transfer all rights granted to it hereunder. This
authorization and release shall also inure to the benefit of the
successors, legal representatives, licensees, and assigns of
the iam2m Literature & Arts Contest.
I have read
the foregoing and fully understand the contents thereof. This
release shall be binding upon me and my heirs, legal representatives,
and assigns. I further release the iam2m Literature &
Arts Contest from any responsibility for injury incurred during
the research or production of the original writing.
_______I,
being the above-named entrant, hereby consent to and join in the
foregoing release.
______________________________
_____________
Signature Date
signed
•• Pledge
of Originality
The following
pledge of originality must be signed by each entrant to the iam2m
40th Annual NCCJ Literature & Arts Program Contest
(iam2m Literature & Arts Contest).
I declare
and avow that the poem, essay or art I am submitting to the iam2m
Contest is my own original work.
__________________________________________
Entrant's
Signature
__________________________________________
Date
A Project
of iam2m, The City of Santa Monica
Web site:
http://www.iam2m.com
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