(please print) Mother's Name:_________________________________________ Child's Name:__________________________________________ Telephone:__________________ Home Address:_________________________________________ City:___________________________Zip:________________ I agree that this photograph of my family members, if present, and me breastfeeding my child will be used by the New Mexico Breastfeeding Task Force to be displayed or reproduced for breastfeeding promotion. I agree that I have no legal or financial right to the photograph once it has been submitted. Check___if names of mother and child may be used in display. Signature of breastfeeding woman:__________________________________Date:____________ Photographers Name:_____________________________________ Telephone:__________________ I agree that this photograph will be used by the New Mexico Breastfeeding Task Force to be displayed or reproduced for breastfeeding promotion. I agree that I have no legal or financial right to the photograph once it has been submitted. Signature of photographer:__________________________________ Contest Dates: -Entries (a 4" by 6" photograph) should be received by May 30, 2010. Send entries to: Isleta WIC Program PO BOX 670 Isleta, NM 87022. -Photos will not be returned Contest Rules: -Entries must have a New Mexico Address. -A completed entry form with release signed by both the photographer and the breastfeeding mother must be included with the photograph. -Contest participants must consent to the reproduction of their photographs for the purpose of promoting good perinatal health and breastfeeding. -The content of the photographs must deal with the subject of breastfeeding and must present breastfeeding in a positive light. -All photographs must be original and contain no copyrighted material. -Studio photos will not be accepted. We cannot use cell phone photos. -One photograph per category. Each photogragh must be clearly labeled with the selected category for entry. Include a title or caption for the photograph. |
Photography Contest Entry Form |
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