Short-Film Contest Entry Form October 23-24, 2010 - Harrisburg, PA Presented by
Part I. Filmmaker Information First Name:
Last Name:
Address: City:
State:
Phone:
Zipcode:
Pennsylvania Chapter
Email:
Part II. Film Information Title of Film: Length of Film: Tell us a little about your Film:
Theme of Film (Place an “x” next to the category you are submitting under, please choose one): ___ Sustainable Communities ___ Locally & Organically Grown ___ Marcellus Shale Drilling ___ Climate Change in PA Part III (Place an “x” next to the statements below and sign and date this document): ___ I hereby give the film contest permission to place my film on the festival’s and related partners’ web sites as well as screen at the Film Festival. ___ I am fully aware of the rules of the film contest and agree with the conditions. ________________________
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Print Name
Date
Signature
Questions??? Email: evergreenfilmfest@gmail.com