SUBMISSION FORM Mail to: YP Quincy, c/o University of Illinois Extension 330 South 36th Street Quincy, IL 62301 Questions?

Contact: Shelby Crow sschoon@illinois.edu www.ypquincy.com

PLEASE PRINT OUT AND COMPLETE THE FORM BELOW AS MUCH AS POSSIBLE. MAIL THIS FORM ALONG WITH YOUR FILM TO THE ADDRESS ABOVE. IF SUBMITTING MULTIPLE FILMS, A FORM MUST BE COMPLETED FOR EACH FILM.
NAME OF FILM: CONTACT PERSON/ SUBMITTING INDIVIDUAL: WRITER: DIRECTOR: GENRE: FILM LENGTH: RELEASE DATE: WEBSITE: CONTACT E-MAIL: CONTACT ADDRESS: CONTACT PHONE NUMBER: CHECK BELOW WHERE APPROPRIATE: PRESS MATERIALS ENCLOSED: I Submitted a film to the Big Dam Film Festival 2006/2007/2008/2009 or 2010: (name of film:________________________________)

I authorize the film described above to be shown at The Big Dam Film Festival 2011 event and for it and any accompanying press materials to be utilized in promotion of the event.

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