Name & Age(if under 18, must be signed by a parent or legal guardian):

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Address:

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City/State/Zip:

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Primary Phone Number:

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Alternate Phone:

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Email Address:

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URL (if any):

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Title of Entry: Screenplay/Film:

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Preferred Screening Format:

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Running Time & Brief Synopsis:

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List any awards, previous festival screenings or broadcasts:

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How did you hear about us?

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I certify that I am the owner of this entry and it is my original work. I am submitting this work for review. While I understand that I retain all rights to ownership of the work, I hereby give A.K.A Cascadia Con and the Northwest Science Fiction and Fantasy Film Festival permission to feature, advertise, display, in whole or in part, the work titled and described above. I also understand that my entry is valid only upon completion of the following conditions: (1) receipt of a copy of the work and this completed signed form, (2) the processing of the entry fee by the festival organization, and (3) when the work is found to be original and owned by me or those I represent.

Submitter Signature(s)

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