The First Combination Special Video Contest Entry Form

EACH ENTRY MUST INCLUDE THE FOLLOWING:
All fields are required.

The URL where your video may be accessed (1 to 12 minutes in length):
NAME:
ADDRESS:
CITY:
STATE / PROVIDENCE / COUNTRY:
ZIP / POSTAL CODE:
PHONE NUMBER:
EMAIL ADDRESS #1 (provide at least two in case an email from Sponsors either bounces or lands in your junk):
EMAIL ADDRESS #2:
VIDEO TITLE (In English if Foreign entry):
URL of writing on which the video is a based:
TOTAL RUNNING TIME (including front and back credits):
ENTRY FEE of $US 10.00, Paid via the PayPal link below:	YES NO
FINAL ENTRY DEADLINE is December 31, 2008. I AM SUBMITTING MY ENTRY WITHIN THIS TIME:	YES NO
I certify that I have read, understood and accept the CSVC Contest Rules and Guidelines.	YES NO
SIGNATURE (If entrant is under 18 years old, the signature of the parent or guardian is required):