Contest Entry

Name: (Required)

Phone or Email: (Required)

Age 13 or older? (Required)

Yes
No

Title of Work: (Required)

Category of Work: (Required)

Poetry
Fan Fiction
Short Story
Creative Nonfiction

I, the undersigned, do hereby consent to and authorize the use by the Oskaloosa Public Library or the City of Oskaloosa, Iowa, or its agents or employees, of any writing or related materials submitted to them by me in connection with any writing contest and any photographs or related materials produced or obtained by them containing my likeness to be used by them for any business use or purpose as they deem appropriate, including but not limited to promotional materials, shows, displays, brochures, mailings, advertising and website. I do further waive any and all claims for reimbursement of any type for the use of said products or materials, and waive any and all claims of any type against the Oskaloosa Public Library or the City of Oskaloosa, Iowa, or its agents or employees arising from or out of the use of the said items by them.

I do further state that I have read the foregoing, am familiar with the contents thereof, and that I have executed this Consent and Release of my own free will. This form shall be binding upon my successors, heirs and assigns.

I have read and agree to the above. (Required)

Yes
No

Please type your name, followed by the year of your birth, as signature. (Required)

Please upload your file in .doc, .docx, .pages, .pdf, or .rtf format. (Required)

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