WAIVER I/We attest to the originality of the work submitted as an entry to the Be the Agent of Change Jingle Making Contest. That the work submitted have neither been submitted in any other contests nor recorded in any foreign and local recording outfit. That I/We have obtained written consent from the parents/legal guardians of minors who participated in the production of the work submitted. NEDA-Caraga is not in any way responsible in my/our inability to secure the necessary permission or consent for the work submitted. That NEDA-Caraga is free and harmless; I/We shall indemnify if necessary, against any and all claims, damages or liability arising from any violation of rights of any third party. By joining this contest, I/We am waiving my economic rights including royalty to the work submitted and irrevocably grant NEDA-Caraga copyright to the work submitted based on Republic Act 8293 – including reproduction, dramatization, translation, adaptation, abridgement, arrangement, exhibition, publication, recording and broadcast. However, NEDA-Caraga shall acknowledge my/our name during the reproduction, dramatization, translation, adaptation, abridgement, arrangement, exhibition, publication, and broadcast of the work submitted. NEDA-Caraga is free to use the work submitted, in any manner or format, for any advocacy activities (marketing, promotions, advertising, and publicity) in all forms of media without compensation including royalty or consideration for additional consent from me/us. Signed this ____ day of _______________, 2014 at _______________, Philippines.
______________________________ Signature over Printed Name
______________________________ Signature over Printed Name
____________________________ Parent/Guardian (Name and Signature)
______________________________ Parent/Guardian (Name and Signature)
Be the Agent of Change Jingle Making Contest Official Entry Form Entry No. ________ (to be filled up by organizers)
Jingle Entry Title: __________________________________________________________________________________ Jingle Duration (including Intro and Extro):
__________ minutes __________ seconds
Instruments Used: __________________________________________________________________ Recorded at _______________________________________________________________________
Participant 1: Composer
Lyricist
Interpreter
Name __________________________________________________________ Address ________________________________________________________ Age ______
Date of Birth ______________ Citizenship ______________
Mobile Phone _________________
Please attach 2x2 photo here
Landline ________________
E-mail Address _________________________ Fax No _________________ Participant 2: Composer
Lyricist
Interpreter
Name __________________________________________________________ Address ________________________________________________________ Age ______
Date of Birth ______________ Citizenship ______________
Mobile Phone _________________
Please attach 2x2 photo here
Landline ________________
E-mail Address _________________________ Fax No _________________ Nimfa Tiu Building I, J.P. Rosales Avenue, Butuan City Tel. Nos.: Trunklines - (085) 342-5774, 360-2055; Fax No. (085) 815-0308; Technical Division - (085) 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.
Entry No. ________ Page 2 of 2 Participant 3: Composer
Lyricist
Interpreter
Name __________________________________________________________ Address ________________________________________________________ Age ______
Date of Birth ______________ Citizenship ______________
Mobile Phone _________________
Please attach 2x2 photo here
Landline ________________
E-mail Address _________________________ Fax No _________________ Participant 4: Composer
Lyricist
Interpreter
Name __________________________________________________________ Address ________________________________________________________ Age ______
Date of Birth ______________ Citizenship ______________
Mobile Phone _________________
Please attach 2x2 photo here
Landline ________________
E-mail Address _________________________ Fax No _________________ CERTIFICATE OF TRUTHFULNESS AND SUBSCRIPTION TO THE RULES AND REGULATIONS OF THE COMPETITION
I am / We are joining the Be the Agent of Change Jingle-Making Contest, understanding and abiding fully and completely with all of the contest guidelines and rules. I / We hereby attest to the above information as accurate and true. Signatures over Printed Name of Participant/s:
_____________________________________ ______________________________________
_____________________________________ ______________________________________
Date / Time Submitted: _____________________ Received By: ____________________________
Nimfa Tiu Building I, J.P. Rosales Avenue, Butuan City Tel. Nos.: Trunklines - (085) 342-5774, 360-2055; Fax No. (085) 815-0308; Technical Division - (085) 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.
