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DRAFT ENT RY FORM City of Wilson Planning Department / City of Wilson Participant name: Address/City/State: Zip: Phone: Email: Name of parent or legal guardian (if participant is under 18): Participant's DOB (if participant is under 18): Image location/closest intersection: Suggested caption: ____________________________________________________________________________ PHOTO SUBMISSION / P E R SONAL CONT E S T / WAIVER AND R E L EAS E / HOLD HARMLESS AGREEMENT

In consideration for receiving permission to participate in City of Wilson Planning Department 2009 Day in the Life of Wilson Photo Contest, I declare and affirm that: T E RMS AND CONDI T IONS 1. I am the individual who took the submitted photograph. 2. I hereby grant to the City of Wilson Planning Department and the City of Wilson to the fullest extent of my rights and interest therein, the unrestricted, irrevocable and exclusive right and permission to use and reuse, publish, print, distribute and reproduce for public display the submitted photograph in whole or in part, composite or retouched in character or form. 3. I have obtained consent from each readily identifiable and/or recognizable person in my photo for the unrestricted, irrevocable and exclusive right and permission to use and reuse, publish, print, distribute and reproduce for public display the submitted photograph. 4. I understand I will not receive a fee or other form of compensation except for the potential to win a one-time contest award. 5. I hereby release, discharge and agree to hold harmless the City of Wilson Planning Department from any and all claims, damages, costs and liabilities that may arise as a result of entering and participating in this photo contest or from any subsequent publication or disclosure of the submitted photograph. 6. The submitted photograph has not been widely published. 7. I am over the age of 18 and have the right to contract in my own name, or if I am not over the age of 18, my parent or legal guardian is signing this agreement on my behalf. 8. I hereby acknowledge that this agreement will be construed, interpreted and enforced according to the laws of the State of North Carolina, in a court of competent jurisdiction in Wilson County, NC. 9. I have read and fully understand the terms and conditions herein and affirm that the foregoing is true and correct.


I understand the terms and conditions herein are contractual and not a mere recital, that this agreement is legally binding and that I have voluntarily signed or agreed to the terms and conditions online of this instrument. Signed: Date: If the photograph was taken by a minor under the age of 18, I affirm that I am the minor's parent of legal guardian and that I consent to the photo being entered in the 2009 Day in the Life of Wilson Photo Contest Signed: Date: HOW TO SUBMI T YOUR ENT RY FORM: 1. If you are mailing photographs, print, sign and send entry form via fax 252.399.2233, or mail attn: Day in the Life of Wilson Photo Contest 112 Goldsboro St PO Box 10 Wilson, NC 27894


Online entry form