Incite Best of Mixed Media Competition Entry Form
Incite Best of Mixed Media Competition Entry Form
Incite Best of Mixed Media Competition Entry Form
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<strong>Incite</strong> <strong>Best</strong> <strong>of</strong> <strong>Mixed</strong> <strong>Media</strong> <strong>Competition</strong><strong>Entry</strong> <strong>Form</strong>Please print this form and mail in with CD.Deadline: November 1, 2012You may submit as many entries as you like, but entries in each category mustbe grouped separately.Please accept my work for consideration in <strong>Incite</strong>. I certify that my entry isoriginal, unpublished, conceived and created entirely by me. I've read and fullyunderstand the rules <strong>of</strong> the competition, and agree to allow North Light Books toreproduce my artwork in print, in electronic or computer-based informationservices, or in promotion materials in the event my entry is selected as a winner.To ensure your eligibility, you must fill out this form completely andaccurately.Signature____________________________________________________Name_______________________________________________________Address_____________________________________________________City_____________________________State________Zip_____________Country_____________________________________________________Daytime Phone ( ) __________________________________________E-mail ______________________________________________________[ ] Please contact me via email with future art competition updates.Fees$25 for the first entry and $20 for each additional entryI am submitting a total <strong>of</strong> __________imagesTotal enclosed (U.S. funds) $__________Method <strong>of</strong> Payment:[ ] Check/money order enclosed (U.S. funds drawn on a U.S. bank; payable toF+W <strong>Media</strong>, Inc.)Charge my: [ ] MasterCard [ ] VisaCard Number______________________________________Signature_________________________________________Exp. Date____________________________Mail completed entry form, CD and jury fee to:<strong>Incite</strong> <strong>Best</strong> <strong>of</strong> <strong>Mixed</strong> <strong>Media</strong> <strong>Competition</strong>8469 Blue Ash Road, Suite 100Cincinnati, OH 45236
ENTRY 1TITLE: __________________________________________________________IMAGE SIZE: HEIGHT: _________________ WIDTH: _________________MEDIUM(S): ______________________________________________________ENTRY 2TITLE: __________________________________________________________IMAGE SIZE: HEIGHT: _________________ WIDTH: _________________MEDIUM(S): ______________________________________________________ENTRY 3TITLE: __________________________________________________________IMAGE SIZE: HEIGHT: _________________ WIDTH: _________________MEDIUM(S): ______________________________________________________ENTRY 4TITLE: __________________________________________________________IMAGE SIZE: HEIGHT: _________________ WIDTH: _________________MEDIUM(S): ______________________________________________________ENTRY 5TITLE: __________________________________________________________IMAGE SIZE: HEIGHT: _________________ WIDTH: _________________MEDIUM(S): ______________________________________________________ENTRY 6TITLE: __________________________________________________________IMAGE SIZE: HEIGHT: _________________ WIDTH: _________________MEDIUM(S): ______________________________________________________ENTRY 7TITLE: __________________________________________________________IMAGE SIZE: HEIGHT: _________________ WIDTH: _________________MEDIUM(S): ______________________________________________________ENTRY 8TITLE: __________________________________________________________IMAGE SIZE: HEIGHT: _________________ WIDTH: _________________MEDIUM(S): ______________________________________________________
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