Send This Form with Each Book Entered to Your T&T National Contact

TYPHLO & TACTUS (T&T) 2017 ENTRY FORM for U.S.

Send this form with each book entered to your T&T national contact:

American Printing House for the Blind 1839 Frankfort Avenue Louisville, KY 40206-0085 Attn: Rob Guillen, T&T Book Competition [email protected]

Entries should reach APH by August 10, 2017

1. Original Books: To be completed for original books especially made for children with visual impairments:

Title ______

Author(s) of the text ______

Creator(s) of the tactile illustrations (if different from the above) ______

______

2. Commercial Books: To be completed for tactile adaptations of commercially- published books (You must receive permission from the book’s print publisher to enter your tactile adaptation in the competition.):

Publisher ______

ISBN ______Copyright date ______

Original title ______

Original author ______Original illustrator______

Name of the creator(s) of the tactile version ______

Tel (_____)______Email ______

continued next page 3. Name and address to which the book should be returned. (Note: the book will be returned to this address as “free matter for the blind” unless you have enclosed with your entry a pre-addressed envelope, pre-paid for another method of delivery.)

Name ______

Address ______

______

Tel (_____)______Email ______

4. Legal representative of the book (person or organisation to be named as the copyright owner if the book is published):

Name ______

Address ______

______

Tel (_____)______Email ______

I declare that this book has been tested/used with children with visual impairments.

If based on a commercially available print book, I declare that I have received permission from the original publisher to enter my tactile adaptation of the book in the Typhlo & Tactus competition. (If you have requested permission but not yet received a reply you may enter your adaptation in the US level of the competition, but it will not be eligible to win the international level of the competition unless permission has been received by that time.)

By my participation at the Typhlo & Tactus competition I agree that:

• I will not receive any royalties.

• I give my permission for the organisers to exhibit my book in a variety of contexts and to quote from it and reproduce photos of it for Typhlo & Tactus publicity purposes.

Signed ______

Date ______Place ______