EmailMe Form - Summer Reading Book Trailer Contest Entry Form

Name *

First Last

Address *

Street Address City State Zip Code

Email *

Phone *

### - ### - ####

My neighborhood library branch is: *

Beatley Central

Barrett Branch

Burke Branch

Duncan Branch

Age Group *

Middle School

High School

Adult

Entry Title *

URL where video is available online *

Parent/Guardian Agreement (required if under age of 18) *

Yes

No

N/A

I have read the rules and guidelines and allow my child to submit an original book trailer to the Alexandria Library. I understand that this work may be posted on the library’s website and/or used in other media outlets (using only first name and last initial to identify).

Parent/Guardian Email (required if under age of 18)

Please provide a parent/guardian email. Once form is submitted a confirmation email will be sent to the parent. If you are under 18 and do not provide a parent/guardian email address you will be disqualified.

Participant Agreement *

Yes

No

I have followed the rules and guidelines as outlined; my work is original work. If my trailer is selected, I agree that the Alexandria Library and/or media outlets may use my work.