July 2014 | Page 5

World Breastfeeding Month Photo Contest Entry Form Name: Organization/Business: (if applicable) Phone Number: Email: Photo Title: Date Taken: Location: Caption: In conjunction with my participation in this contest, I hereby declare the followings: 1. That I am the lawful author/copyright owner/authorized party of this image/works submitted. 2. That I give Allen County Breastfeeding Coalition and its partners the absolute rights and permission to the copyrights to use or reuse, to publish or republish and to produce the image/works that I have submitted. 3. That I have sought relevant permission, and authority for the models/persons/individuals involved and venue and image of props used in my submitted works. I hereby declare that I indemnify Allen County Breastfeeding Coalition any of all liability claims or legal claims as a result of my submission. 4. That I have met all the rules and regulations stated for this contest. Signature: …………………………………………………………… Date: ………………………………………..