ENTRY FORM

To be submitted to the Concierge Staff of your nearest Casino Filipino branch OR mail to:

Corporate Communications Department Philippine Amusement and Gaming Corporation 6th Flr., PAGCOR Hyatt Corporate Bldg. 1588 MH del Pilar corner Pedro Gil Sts., Malate, Manila

Please check the appropriate box and print with BLOCK letters.

CATEGORY: MEDIUM: NAME: ADDRESS:

NON-Professional (13-23 yrs. old) Oil

(Last Name)

Professional (24 yrs. old and above)

Pastel

Watercolor
(First Name) (Middle Name)

(House No.) (City)

(Street) (Province) (Landline)

(Barangay) (Zip Code) (Mobile)

AGE: Email ADDRESS:

CONTACT NOS.:

SCHOOL/ UNIVERSITY: ADDRESS OF SCHOOL/ UNIVERSITY: LEVEL/ COURSE: IF WORKING, OCCUPATION: COMPANY NAME: OFFICE ADDRESS: ENTRY TITLE: BRIEF DESCRIPTION:

This is to certify that all information provided above are true and correct, that I have read and understood the rules of the 1st PAGCOR National Art Competition, and that I will abide by the competition rules and respect the decision of the Board of Judges. I further attest that my submitted entry is my original artwork, and that it has never been entered in any competition nor has been printed commercially. Moreover, by participating in this competition, I am giving PAGCOR the exclusive right to use my artwork for the PAGCOR 2013 calendar and other communication materials of the corporation in the event that this entry wins any award in the 1st PAGCOR National Art Competition.

Printed Name & Signature of Contest Participant