Green Flicks Illawarra Short Film Competition

Green Flicks Illawarra short film competition

Entry form – individuals All fields are compulsory. Read the Conditions of Entry before you fill out this form. A Consent to Participate form will need to be submitted for each participant featured in the film.

Primary contact details Yourself, a teacher, parent or guardian.

Full name: Click or tap here to enter text.

Street address: Click or tap here to enter text.

Phone number: Click or tap here to enter text.

Email: Click or tap here to enter text.

Date of birth: Click or tap here to enter text.

Age category Based on your age at 8 September 2017. 12–14 years ☐ 15–17 years ☐ 18 –24 years ☐

About your film

Film title: Click or tap here to enter text.

Length of film: Click or tap here to enter text. Name of your primary school or high school/s for all group members (if applicable): Click or tap here to enter text. Short description of your film (no more than 200 words): Click or tap here to enter text. APRA/AMCOS licence number if applicable: Click or tap here to enter text. Confirmation

☐ I have read and understood the Terms and Conditions of Entry and confirm that:

1. my entry complies with the Terms and Conditions of Entry 2. my parent/legal guardian has provided consent for me to submit this entry (if under 18). Note: If a parent or guardian has provided consent to enter, electronic submissions must be sent from the parent or guardian’s own e-mail address to confirm the reliability of this consent 3. all film participants’ consent has been obtained as per Clause 13 in the Terms and Conditions.

Signed (insert digital signature or type name): Click here to enter text.

Date: Click or tap to enter a date.

Office of Environment and Heritage, 59 Goulburn Street, Sydney South NSW 2000 Phone: 131 555 (environment information and publications requests) Email: [email protected]; Website: www.environment.nsw.gov.au OEH 2017/0262; June 2017.

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