International Photography Contest Entry Form

International Studies Program, IPFW

 

Please PRINT your responses.  In order for submissions to be considered, this form must be submitted in paper copy to Professor Nancy Virtue, CM 267, Department of International Language and Culture Studies, IPFW, Fort Wayne, IN  46805.  Photos must be submitted electronically to virtue@ipfw.edu or may accompany this form on a CD.  Deadline: Friday, April 13, 2007, no later than 5 p.m.

 

All communication about the contest will be done by email notification.

 

Name of Entrant: __________________________________________________________________

(Last/Family Name)                              (First Name)                             (Middle Name)

 

Mailing Address: ___________________________________________________________________

(Number & Street)                               (City, State, Zip code)

 

E-mail Address: ___________________________________________________________________

 

Phone Number: _(____________)_____________________________________________________

 

Affiliation with IPFW:  (please circle one)

 

Student                        Faculty                         Staff

 

Number of entries (no more than 6):  ___________________________

 

Title(s) of Work(s):                   Where taken:              When taken:     Which category*:

 

1)__________________________________________________________________

 

2)__________________________________________________________________

 

3)__________________________________________________________________

 

4)__________________________________________________________________

 

5)__________________________________________________________________

 

6)__________________________________________________________________

 

I heard about this photography contest from _______________________________

 

*Categories: a) favorite cultural interaction; b) most picturesque or unusual; c) mastodons abroad.

 

In signing this entry form, I affirm that the above information is complete and accurate, that the entries are my own work, and that I have read, understand, and am complying with all conditions and rules of the competition.

 

Signature: _________________________________ Date: ___________________, 2007