Human rights photo competition entry form - The Human Rights Centre

Human rights photo competition entry form
Application Deadline: November 16 2008
Please complete this form in English, Georgian or Russian
Family name
Given name
Date of birth (dd-mm-yy)
Place of Birth
Place of Work
Employer
Address
Country
Phone number (cell phone is preferable)
Personnel e-mail:
Number of entries
Photo story Poster Human rights photo shot
I hereby declare that:
a. I am the author of photographic material I submit.
b. I have the right to distribute the image(s) I submit.
c. The material I submit was produced in 2008.
d. In case of winning the competition, I give the Human Rights Center permission
for the unlimited use of the submitted material for human rights purposes under
the auspices of the Human Rights Center without any remuneration being due.
Place
Date
Name
Signature

Entry details
Picture
sequence Category Date Place Brief caption information Black & white/
color
YOUR PICTURES AND THIS COMPLETED ENTRY FORM MUST BE SUBMITTED TO THE HUMAN RIGHT CENTER NO LATER AFTER
OCTOBER 1 AND NO LATER THAN NOVEMBER 16 IN 2008
Send to: nino@hridc.org or Human Rights Center, 3a, Kazbegi Ave., Entrance 2, IV floor, Apt. 22, Tbilisi 0160, Georgia.