Be the Agent of Change Canvas Painting Contest Contest Registration Form Name of Participant: Last Name
First Name
Middle Name
Last Name
First Name
Middle Name
Name of Coach: Address: Street
Barangay
Municipality/City
Province
Name of School: Schools Division: Birthdate: Contact Information: Mobile Number
E-Mail Mail Address
Recommending Approval: _______________________
Approved By: ___________________________ Schools Division Superintendent
Nimfa Tiu Building I, I J.P. Rosales Avenue, Butuan City Tel. Nos.: Trunklines - (085) 342-5774, 360-2055; Fax No. (085) 815-0308; Technical Division-(085) Division 341-4195; Operations Division-(085) 341-4066 Email:
[email protected] http://caraga.neda.gov.ph/ and rgisn-caraga.neda.gov.ph
Be the agent of change.
Waiver I attest to the originality of the work submitted as an entry to the Be the Agent of Change Canvas Painting Contest. By joining this contest, I am waiving my economic rights rights to the works submitted and irrevocably grant NEDA-Caraga Caraga copyright to the works submitted based on Republic Act 8293 – including reproduction, dramatization, translation, adaptation, abridgement, arrangement, exhibition, publication, and broadcast. However, However, NEDA-Caraga NEDA shall acknowledge my name during the reproduction, dramatization, translation, adaptation, abridgement, arrangement, exhibition, publication, and broadcast of the works submitted. NEDA-Caraga Caraga is free to use the works submitted, in any manner manner or format, for any advocacy activities (marketing, promotions, advertising, and publicity) in all forms of media without compensation or consideration for additional consent from me. Signed this _____ day of ____________, 2014 at ________________, ________________ Philippines. ________________________ Signature over Printed Name ________________________________________ Parent/Guardian (Name and Signature)
Nimfa Tiu Building I, I J.P. Rosales Avenue, Butuan City Tel. Nos.: Trunklines - (085) 342-5774, 360-2055; Fax No. (085) 815-0308; Technical Division-(085) Division 341-4195; Operations Division-(085) 341-4066 Email:
[email protected] http://caraga.neda.gov.ph/ and rgisn-caraga.neda.gov.ph
Be the agent of change.