Name of Entrant:___________________________________________________

Date:_______________

For Group Submissions- Name and birthday of all students in the group (no more than 3):

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Home Address:________________________________________________________________________

City: _________________________________ State:____________  Zip Code:_______________

School/ Affiliation (if applicable): _________________________

Title of Video Submission:________________________________________

Length (min:sec):_______ (must be under 4:00 minutes)

File Type and Size of Video:________________________

File Name:___________________________

Video References and Citations (for copyright purposes):

________________________________________________________________________________

________________________________________________________________________________

Reason for Participation:_______________________________________________________________

Future Goals:__________________________________________________________________________

________________________________________________________________________________

        

In the space provided below, please describe your video and its significance.

        

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Release

Ownership and title to the work/video will remain with entrant subject to the licenses granted herein. The entrant grants to the Klamath-Siskiyou Wildlands Center and its subsidiaries a non-exclusive, perpetual license to:

Entrant Signature:___________________________________________ Date: ________________

Parent/Guardian Signature:____________________________________ Date: ________________

(If applicant is under the age of 18)

Please Submit Entry Form to:

Siskiyou FilmFest

Klamath-Siskiyou Wildlands Center

POB 102 Ashland OR 97520

Questions ? Email: allee@kswild.org

 

ENTRIES MUST BE POSTMARKED BY Dec. 20th, 2019