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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

Picture
Join others who take advantage of this opportunity!  Click on the amazon smile logo to designate the FLT as your charity of choice.  Amazon.com will then donate one-half percent, 0.5%, of each purchase to the FLT when you shop at https://smile.amazon.com .
Combined, these small but regular contributions from Amazon.com are a significant source of revenue to help SAVE THE LAND.


Get Started with the Farmington Land Trust:

Become a Member
Donate to the Landmark Fund
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                       Farmington Land Trust, Inc.           128 Garden Street #C          Farmington, CT 06032          860.674.8545