INDIE SHORT FILM COMPETITION 2012
Short Film Entry Form
MAIL ALL ENTRIES TO:
Indie Short Film Competition
P.O. BOX 1185
Fort Lauderdale, FL 33302 U.S.A. |
EACH ENTRY MUST INCLUDE:
1.) A completed Entry Form with an original signature.
2.) Short
Film up to 40 minutes in length on DVD or VHS regardless of original shooting format.
* Entries must be NTSC format only. PAL is NOT accepted.
* Foriegn DVD's must be formatted
for Region Code 1 (North America) or Region Code 0
(Universal).
3.) Entry Fee (US Currency Only)
ENTRY DEADLINE: Entries must be postmarked no later than August 31, 2012!
PLEASE PRINT CLEARLY
NAME: ________________________________________________________________________________
ADDRESS: ____________________________________________________________________________
CITY: _______________________________________ STATE / PROVIDENCE: ____________________
ZIP / POSTAL
CODE: __________________________ COUNTRY: _______________________________
PHONE NUMBER: _____________________________
EMAIL: __________________________________
Title of Short Film / Video: (In English if Foreign entry)
______________________________________________
Total running time: (including front and back credits)
_________________________________________________ Check ONE category only
o Fiction (any genre) o Documentary
o Animation o Music Video
o Student Film
Name of film school
or university/college if entering a student film __________________________________ Title of song and
artist or group performing if entering a music video ________________________________
Please write
a short synopsis of your story. (Please print clearly - attach to entry form if more room is needed.)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Director(s): _____________________________________________________________________________
Producer(s): ____________________________________________________________________________
Writer(s): ______________________________________________________________________________
Company Name: (if applicable) _____________________________________________________________
How did you hear about the Indie Short Film Competition: ________________________________________
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ENTRY FEES - You Must Check One Box
Early
Entry Deadline - Entries postmarked by May 31, 2012 or earlier! |
o
Under 20 Minutes: $40.00 |
o 21 to 40 Minutes: $55.00 |
Regular Entry Deadline - Entries postmarked
by July 31, 2012 or earlier! |
o
Under 20 Minutes: $45.00 |
o 21 to 40 Minutes: $60.00 |
Final Entry Deadline - Entries postmarked
by August 31, 2012 or earlier! |
o
Under 20 Minutes: $50.00 |
o 21 to 40 Minutes: $65.00 |
Select a method of payment: o CHECK / MONEY ORDER o VISA o MASTERCARD
Make your check or
money order payable to: Indie Short Film Competition
Payment from countries outside the U.S.A. must be in the form of
a U.S. Bank Check, money order, cash, or credit card.
IF
PAYING BY CREDIT CARD
Card number: ____________________________________________
Expiration Date: _________________
Name on card: __________________________________________________________________________
Complete Billing Address: _________________________________________________________________
Cardholder
Signature: ____________________________________________________________________
I certify that I have read, understood and accept the Indie Short Film Competition rules & regulations as they appear on the competition website.
Entrant's Signature:
_______________________________________________ Date: _________________
If the entrant is under 18 years old, the signature
of the parent or guardian is required.
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