Contest Entry Form | storytubes.info

Type of Entry:

YouTube TeacherTube

YouTube Video URL:
(what's this?)

TeacherTube Video URL:
(what's this?)

Title of Book Featured in Video:

Author of Book featured in Video:

Category:

    *Just for Fun Entrants are not eligible for prizes!

Is Entry for a Group?

Yes No

Use Library, School, City and State Information for ALL Group Members
Selecting the checkbox will copy/paste above information into the various group fields.

Primary Member Information (This will be the Main Contact Information for the Group)

Entrant's First Name:

Entrant's Last Name:

Public Library Name:

School Name:

Enter 'None' for School Name if Adult Entrant

Entrant's State or Province:

    If Other is chosen, you must enter from where in the field that
    shows below.

I, the adult representative or adult entrant,
have read the rules and agree to comply:

(contest rules)

Adult's Email Address:

    Please add storytubes@storytubes.info to your e-mails' contacts
    and/or safelist!

Second Group Member Information

Entrant's First Name:

Entrant's Last Name:

Public Library Name:

School Name:

Enter 'None' for School Name if Adult Entrant

Entrant's State or Province:

    If Other is chosen, you must enter from where in the field that
    shows below.

I, the adult representative or adult entrant,
have read the rules and agree to comply:

(contest rules)

Adult's Email Address:

    Please add storytubes@storytubes.info to your e-mails' contacts
    and/or safelist!

Third Group Member Information

Entrant's First Name:

Entrant's Last Name:

Age:

Choose one.... 5 yrs old 6 yrs old 7 yrs old 8 yrs old 9 yrs old 10 yrs old 11 yrs old 12 yrs old 13 yrs old 14 yrs old 15 yrs old 16 yrs old 17 yrs old 18 yrs old Adult

Public Library Name:

School Name:

Enter 'None' for School Name if Adult Entrant

Entrant's State or Province:

    If Other is chosen, you must enter from where in the field that
    shows below.

I, the adult representative or adult entrant,
have read the rules and agree to comply:

(contest rules)

Adult's Email Address:

    Please add storytubes@storytubes.info to your e-mails' contacts
    and/or safelist!

Fourth Group Member Information

Entrant's First Name:

Entrant's Last Name:

Age:

Choose one.... 5 yrs old 6 yrs old 7 yrs old 8 yrs old 9 yrs old 10 yrs old 11 yrs old 12 yrs old 13 yrs old 14 yrs old 15 yrs old 16 yrs old 17 yrs old 18 yrs old Adult

Public Library Name:

Entrant's City:

Enter 'None' for School Name if Adult Entrant

Entrant's State or Province:

    If Other is chosen, you must enter from where in the field that
    shows below.

I, the adult representative or adult entrant,
have read the rules and agree to comply:

(contest rules)

Adult's Email Address:

    Please add storytubes@storytubes.info to your e-mails' contacts
    and/or safelist!

Fifth Group Member Information

Entrant's First Name:

Entrant's Last Name:

Age:

Choose one.... 5 yrs old 6 yrs old 7 yrs old 8 yrs old 9 yrs old 10 yrs old 11 yrs old 12 yrs old 13 yrs old 14 yrs old 15 yrs old 16 yrs old 17 yrs old 18 yrs old Adult

Public Library Name:

School Name:

Enter 'None' for School Name if Adult Entrant

Entrant's State or Province:

    If Other is chosen, you must enter from where in the field that
    shows below.

I, the adult representative or adult entrant,
have read the rules and agree to comply:

(contest rules)

Adult's Email Address:

    Please add storytubes@storytubes.info to your e-mails' contacts
    and/or safelist!

Would you like this video to be included in Runner-Up Online Voting or Wild Card [Participant] Online Voting in April, 2011 if it does not win a Judges' Choice Award or Honorable Mention Award?

Yes No