| First Name: * | |
| Last Name: * | |
| Street Address: * | |
| Address Line 2: | |
| City: * | |
| State: * | |
| Zip Code: * | |
| E-mail Address: * | |
| Phone Number: * | |
| Category of Photograph: * | |
| Photo Title * | |
| Photo Description (location/site, date taken, etc.): * |
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| Attach File (Files MUST BE 2.4 mb or smaller. Email larger files, up to 10 mb, to photocontest@silosandsmokestacks.org with the "Photo Title" used on this form as the subject): |
|
| Photos containing recognizable people must be accompanied by a signed model release form. I will be submitting the form via: * |
Email (email form to photocontest@silosandsmokestacks.org)
Fax (send fax to 319-234-8228)
not applicable |
| By checking below, I verify that a) I have read all of the guidelines and agree to abide by them for the purpose of this contest. b) I acknowledge that my image will become part of Silos & Smokestacks National Heritage Areas permanent collection of photographs. c) I am the photographer of the accompanying photograph and/or hold all rights therein. * |
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| Date Submitted: * |
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| |
| * Required |
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