Student Video Challenge Application
This Entry Form must be completed and submitted for any video to be accepted by NCPA as an entry into the contest, and for that video to be considered by the judges. Any video that is not accompanied by a completed Entry Form will be disqualified. Every person who participated in the creation and production of the video, including but not limited to writers, designers, performers, and editors, must sign in the table below. By signing this document, each Entrant agrees to all of the terms set forth in the Statement of Eligibility, License, and Release above.
School or College of Pharmacy *
Your answer
Video Title *
Your answer
Primary Contact Name *
Your answer
Primary Contact Email *
Your answer
Primary Contact NCPA Member ID
Your answer
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