PHOTOGRAPH CATEGORY:

SNAP - PHOTOS (Catching Time)

Competition Entry Form

Please tick þ the box that applies below:

The photograph is submitted by:

r Individual student

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

Please tick þ the box that applies below:

At the time of submitting the entry I am/we are attending:

r Secondary Education (Post-Primary)

r Further Education

r Higher Education

r 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 form (found on the last page), the details of all members of the group should be listed.

First Name: ______Surname: ______

Address/City/Post Code/Country: ______

Email address: ______Telephone Number: ______

Skype address (if available): ______

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

______

Institution/School Details:

Name: ______

Address/City/Post Code/Country: ______

Details about the Photograph:

Photograph caption: ______

Date when photograph was taken: ______

Details of location where photograph was taken: ______

______

Short description of the photograph and how it is linked 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):


Please tick þ the boxes below:

Has written permission been sought from individuals appearing in the photograph (parents in the case of children) to have the photograph:

·  entered for the PERL competition and

·  used by PERL and its partners for promotional and/or educational purposes in the promotion of sustainable and responsible living

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

PERL if requested

r NO (Please explain) ______

______

Please tick þ the boxes below:

r I/we certify that this photograph is my/our own original work, has not been

previously published and is not in breach of any copyright rules or regulations

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

hidden advertising

r I/we permit PERL and its partners to use/reproduce this photograph for promotional

and/or educational purposes in the promotion of sustainable/responsible living

r I/we have read and accept the rules of the competition found at

http://www.perlprojects.org/

Signature: Date:


Don’t forget:

·  Scan the signed entry form and email the form (in PDF) with the photograph (in the required format) to: Ensure that the entry form and photograph are sent together as attachments in the same email

·  Include the following title in the subject line of the email when sending: ’Photograph Competition PERL 2013’.

·  Competition closes at midnight 13th December 2013 (Central European Time)

Group Entries

·  In the case of a group entry all members of the group must complete and sign the form below

·  By signing below you are certifying that this photograph is your own original work and you are permitting PERL and its partners to use it for promotional and/or educational purposes in the promotion of sustainable/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. / r Secondary
Education
(Post- Primary)
r Further Education
r Higher Education
r Other (Please state type of Education)
______/ r Secondary
Education
(Post- Primary)
r Further Education
r Higher Education
r Other (Please state type of Education)
______/ r Secondary
Education
(Post- Primary)
r Further Education
r Higher Education
r Other (Please state type of Education)
______
I have read and I accept the rules of the competition.
SIGNATURE (of each member of group)