Keep the Memories Coming! Conneaut Lake Institute,
Inc. Please include this completed form with your submission and entry fee ($4.00 per image). Keep the Memories Coming! Photo Contest will be held during Conneaut Lake Park's 2005 season, May 28th through September 5th. Please print legibly. Conneaut Lake Institute, Inc. will not be held responsible for late, misdirected or damaged prints. All images are to be in a printed 8" x 10" format and mailed to the above address no later than September 20, 2005. Conneaut Lake Institute, Inc. occasionally uses photographs for purposes of marketing, advertising, promotion and fund-raising projects. The images you submit for this contest may be used for these purposes. Copyrights remain the property of the photographer. However, Conneaut Lake Institute, Inc. may seek permission of use for the specific purpose of marketing, advertising, promotion and fund-raising projects. I, _____________________________________________, do hereby grant Conneaut Lake Institute, Inc. the right to use, without fee or payment of any kind, my photographs for use in further promoting Conneaut Lake Park and the surrounding area. Should one of my images be used for the purposes outlined in the Contest Rules, Conneaut Lake Institute, Inc. will seek specific permission before publication. Signature__________________________________________Date________________________ If under 18, signature of parent or guardian____________________________________________ Images that are not accompanied by this Consent and Release Form will not be eligible for this contest. Please print legibly. Image Title:____________________________________________________________________ Category: [] Model Release enclosed Entry Fee enclosed ($4.00 per image)____________________Number of images_______________ Name_________________________________________________________________________ Address_______________________________________________________________________ Phone___________________________________Email__________________________________ Thank you for your
interest in Conneaut Lake, Pennsylvania! |