AFBC 100 Mile House Entry Identification Form
* This form will be kept by an external third party until after the selection of the winning entries. Each submission requires its dedicated Identification Form.
Unique Transaction ID *
As issued by Paypal
Email Address associated to submission fee during the Paypal process *
For internal reference only
Is this a Student Submission? *
If this is a student submission, please provide the Name of the Institution
Otherwise, please skip this question.
Student Number(s)
If more than one, separate with a comma and space
Submission Title *
Please avoid all-caps
Name of Applicant (Primary Contact) *
Last Name, First Name (For Example: Taller, George)
Please list ALL Team Members (if applicable)
Include name of Applicant, separate with a comma and space, in specific order of your choosing. (For example: John Appleseed, Beth Jones, George Taller.)
Applicant Mailing Address *
Applicant Phone Number *
Applicant Email Address *
Alternate Email Address *
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