Entry Form

ENTRY FORM for the MORE THAN JUST MUD MiNiFLiCK Contest

Name: _________________________________________________________________________ Address: _______________________________________________________________________ Phone: ___________________________ E-Mail: ______________________________________

Film Title: ______________________________________________________________________ Total Running Time: _________________ Genre: _____________________________________ (3 minutes or less, including credits)

Team Members: ________________________________________________________________ Number of Crew (technical): _________ Number of Cast (actors): _________ Camera Make and Model: _________________________________________________________ Editing Software: ________________________________________________________________

By entering the “More Than Just Mud” MiNiFLiCK Contest and signing below, I certify that: i) I have read, understood, complied with, and agree to the contest’s “Official Rules”. ii) I have read, understood, complied with, and signed the contest’s “Pledge”. iii) The film submitted is my original work created for this contest. iv) I have acquired the necessary rights for all copyrighted material--audio, visual or otherwise. v) I release and indemnify the Raincoast Education Society of any and all liability. Signature: _____________________________________________ Date: ___________________ If you are under 18 years old, your parent or guardian’s signature is required: Parent/Guardian Signature: ________________________________ Date: ___________________

This contest is sponsored by the Raincoast Education Society with funding from the Habitat Conservation Trust Fund.