BOOK
‘EM FOUNDATION’S FIRST ANNUAL SHORT STORY CONTEST ENTRY FORM
(Type or print legibly)
Child’s Name ________________________________________________ Age as of
9/15/06____
Mailing address
__________________________________________________________________
City/State/Zip
___________________________________________________________________
Grade in school
__________________________________________________________________
Title of Story ___________________________________________________________________
Number
of Words ________ (Refer to contest
rules for story length)
By
entering the Book ‘Em Foundation’s (BEF) Short Story Contest, I give
permission for the BEF to use this work, which will be credited to the
entrant/author, as it wishes, including, but not limited to, display, promotion,
reproduction and distribution in all media and the right to create, perform,
display and distribute derivative works. I
also give them the right to use the entrant/author’s name, likeness and
biographical material in connection with the work.
I understand the stories may not be returned.
I release the
BEF, Waynesboro Police Department, sponsors and the officers, directors,
employees, licensees and successors from any liability in connection with this
Contest submission.
I
acknowledge that I have read this consent and release prior to signing it and
that I understand its contents.
I
warrant that this child alone has created the story text for this Contest.
Parent/Guardian Signature _____________________________email
address______________________
Printed name ________________________________________ Date _____________________
Mailing address _______________________________________________________________
City/State/Zip _______________________________________ Phone (____)
__________________
Deadline for receipt of entries is:
September 15, 2006
Please send entries to:
BEF Short Story Contest
C/O Waynesboro Police Department
Attn: Officer Kearney
250 S. Wayne Ave.
Waynesboro, VA 22980