SUBMISSION FORM (TO BE PRINTED OUT, FILLED OUT AND SENT WITH SUBMISSION)

DATE SUBMITTED:

 

YEAR ORIGINAL CONTENT WAS CREATED:

DESCRIPTION OF CONTENTS:

 

 

 

FORMAT OF CONTENT (e.g., PAL or NTSC video, JPEG, MP3, etc.):

 

 

CBEATOR{S} OF THE CONTENT OF THE SUBMISSION:

 

 

 

SIGNATURE(S) OF CREATOR(S) giving PERMISSION for use in the

proposed movie and/or unlimited application for the promotion of

World Tai Chi & QiGong Day AND for materials to be retained:

 

 

 

NAME OF CLUB OR GROUP (if applicable) and LOCATION featured

(This information will be included in film or publicity credits if the

Submission is selected for inclusion):

 

 

SIGNATURES OF THOSE APPEARING IN THE SUBMISSION indicating their AGREEMENT for the use of their image, likeness, and/or voice (add extra pages as needed):

 

SIGNATURE                                      LOCATION                                        DATE SIGNED

 

__________________________    __________________________    _______________

 

__________________________    __________________________    _______________

 

__________________________    __________________________    _______________

 

__________________________    __________________________    _______________

 

__________________________    __________________________    _______________

 

__________________________    __________________________    _______________

 

__________________________    __________________________    _______________

 

Mail your Submission NO LATER THAN APRIL 4TH, 2006 to:

Diane Douglas
350 Ward Avenue, Suite 106-126
Honolulu, HI 96814

email contact regarding Submissions: endoftheday@mac.com