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E N T R Y F O R M

FIRST NAME MIDDLE NAME LAST NAME

ADDRESS

CITY STATE

ZIP CODE COUNTRY

E-MAIL ADDRESS

TITLE OF PHOTOGRAPH

DESCRIPTION OF PHOTOGRAPH

I hereby certify that the photo I have submitted is my original work and has never been copyrighted or, if copy-
righted, that I am the sole copyright owner. I am entering this photo as an honest and true effort of my personal creativity.
I understand that if my work is accepted, Filipinas retains the rights to publish the photo in its magazine, advertising, mar-
keting materials and/or website, or for any purpose Filipinas deems fit.

SIGNATURE DATE

Please mail entry to:


Filipinas Magazine
1486 Huntington Avenue, Suite 300, South San Francisco, CA 94080