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: ………………………………………..