Video Contest Entry Form

Videographer Profile and Release


Name_________________________________________ Age__________
Address______________________________________________
School_______________________________________________
CONTACT INFO (please indicate preferable means of contact)
Email________________________________________________
Phone number ________________________________________
Text _________________________________________________
Video url_____________________________________________
Video Title ___________________________________________________________________________


Please do not submit audio with music that is not original or open source unless you have received a transferable license to use it. 
RELEASE: I understand that by submitting my video I grant the Farmington Land Trust, Inc the use of all or part of my (my child’s) work product for promotion of the Farmington Land Trust and its properties.



Signature of videographer (and if under eighteen, a parent or legal guardian)
Farmington Land Trust, Inc., The Canal House, 128 Garden Street, Farmington, CT 06032 
Phone: (860) 674-8545,  E-mail:  farmingtonland.trust@snet.net
 www.farmingtonlandtrust.org