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Make two copies of this
form for each entry. Attach one form to the back of the entry or box.
Attach the other form to the master. Please type or print very neatly.
| Category Name.............................................................................. | |
| Subcategory Letter and Number.............................................................. | |
| Single piece........ or Campaign.......... | Number..........of............. |
| Firm Name................................... | Contact.................................... |
| Address ................................................................................... | |
|
..........................................................................................
|
|
| Phone......................................... | Fax........................................ |
| E-mail .................................................................................... | |
| Entry Title............................................................................... | |
|
Entry Address (for internet entry) http://................................................. |
|
| Client........................................ | Client Contact.............................. |
| Copywriter................................................................................. | |
| Art Director............................................................................... | |
| Creative Director.......................................................................... | |
| Account Manager............................... | Production Manager.......................... |
| Photographer.................................. | Illustrator................................. |
| Printer.................................................................................... | |
| Agency Producer............................................................................ | |
| Audio Production Company................................................................... | |
| Film/Video Production Company.............................................................. | |
| Director...................................... | Talent...................................... |
| Composer/Lyricist.......................................................................... | |
| Other Credits.............................................................................. | |
| Date First Aired, Published, Posted or Mailed.............................................. | |