PORTCONMAINE 2008 ANIME MUSIC VIDEO CONTEST SUBMISSION FORM Please print or type clearly, to avoid any embarrassing "I interpreted the horrible handwriting as best I could" accidents. Submitter's/Submitters' Real Name/Names (up to three people in a group): 1st: ___________________________________________________________________ 2nd: ___________________________________________________________________ 3rd: ___________________________________________________________________ Street Address: ________________________________________________________ City: _______________________________ State/Province: ________________ Country: ______________________ Zip/Postal Code: ________________ Evening (or Weekend) Phone Number: _____ -- _____ -- _______ Complete E-mail Address (only one per person): 1st: ___________________________________________________________________ 2nd: ___________________________________________________________________ 3rd: ___________________________________________________________________ If there are enough entries, we will divide the contest into categories. Please choose one category for each video. MUSIC VIDEO TITLE SLATE INFORMATION Name to Appear in Credits (if *different* from your everyday name): ________________________________________________________________________ Video #1 Music/Song Title (required): ___________________________________________ Artist (required): _____________________________________________________ Album (if you know it): ________________________________________________ Video Footage Used (list as many as possible): _________________________ ________________________________________________________________________ ________________________________________________________________________ Title of Video (if *different* from the song title): ________________________________________________________________________ Category: |__| Dramatic, |__| Action, |__| Comedy Date AMV Completed (approximately): ______ / ______ / ________ Video #2 Music/Song Title (required): ___________________________________________ Artist (required): _____________________________________________________ Album (if you know it): ________________________________________________ Video Footage Used (list as many as possible): _________________________ ________________________________________________________________________ ________________________________________________________________________ Title of Video (if *different* from the song title): ________________________________________________________________________ Category: |__| Dramatic, |__| Action, |__| Comedy Video #3 Music/Song Title (required): ___________________________________________ Artist (required): _____________________________________________________ Album (if you know it): ________________________________________________ Video Footage Used (list as many as possible): _________________________ ________________________________________________________________________ ________________________________________________________________________ Title of Video (if *different* from the song title): ________________________________________________________________________ Category: |__| Dramatic, |__| Action, |__| Comedy AUTHORIZATIONS I/We hereby certify that the Anime Music Video/Short Film I/We have submitted is my/our own work, or that I am an authorized agent of a third party entering on behalf of said party. 1st Signature: _____________________________________ Date: _____________ 2nd Signature: _____________________________________ Date: _____________ 3rd Signature: _____________________________________ Date: _____________ I/We grant PortConMaine permission to show my/our Anime Music Video/Short Film, and to copy it for distribution with the stipulation that no fee is to be charged for the copies. 1st Signature: _____________________________________ Date: _____________ 2nd Signature: _____________________________________ Date: _____________ 3rd Signature: _____________________________________ Date: _____________ Submissions not received by April 20th 2008 will be rejected.