Contact Information
First name:

Your given name or common name

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Last name:

Your family name or surname

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Email:

A valid email address so we can contact you

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Phone:

Your preferred phone number

Optional
Date of Birth:

Eg 1980-10-24

Optional
Gender:
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Address:
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City:
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Province:

(Or state)

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Postcode:

(Or zipcode)

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Country:
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Note: If you reside outside of Canada/US then please use the Addtional Information box at the end of the form to add any phone numbers that won't fit into the preformatted boxes above. Thanks!
Entrant Information
Name/Studio

(to appear in credits)

Required

Entry 1

Video Title:

(to appear in credits)

Required
Music/Song Title:

(to appear in credits)

Required
Music/Song Artist:

(to appear in credits)

Required
Duration:

(min/sec)

Required
minutes seconds


Source Footage:
(if more than 3, enter various)
Required

Elements:

(select your top 4 only in order of preference)




Delivery URL

Please provide the address including http:// or https://

Required

Entry 2

Video Title:

(to appear in credits)

Required
Music/Song Title:

(to appear in credits)

Required
Music/Song Artist:

(to appear in credits)

Required
Duration:

(min/sec)

Required
minutes seconds


Source Footage:
(if more than 3, enter various)
Required

Elements:

(select your top 4 only in order of preference)




Delivery URL

Please provide the address including http:// or https://

Required




Additional Information:
If you have any other additional information, please provide it here:
Signature of Entrant
By signing you agree to abide by the contest rules and any event policies applicable to the contest.
In submitting this form, I hereby certify that all the above information is correct and the music video entries submitted is the creations/own work of the video creator(s) as named on this form.

Signature:

Please type your name

Required
Date: 2017-03-28

Required We require this information in order to proceed.
Recommended While we do not require this information it would definitely assist us which could in turn help you.
Optional We do not require this information but we may find it helpful.