Application to be made by Tuesday 21 June 2016. For a group entry, submit only one application form.

SCHOOL/COLLEGE DETAILS:

PLEASE COMPLETE FORM IN BLOCK CAPITALS

Centre number:

Centre name:

Teacher email:

Tel No.:

Teacher name:

ENTRANT(S) DETAILS:
Is this an individual or group entry? INDIVIDUAL/GROUP (delete as necessary)
Name of entrant(s)

Email address

D.O.B.

16 or under (tick)
(on 31 August 2016)

1.

2.
3.

4.

DETAILS OF PRODUCTION:
Categories: Film Extract/Short Film/Music Video/TV Sequence (Please Note: Film Trailers/Adverts are not accepted)
Category: (one of the above)
Length of Production:
Title of Production:

Brief Description of Production:

(75 words)

Date completed:

Group Member

Group members role

2.

2.

1.

1.

3.

3.

4.

4.

FOR MUSIC VIDEO ENTRY ONLY:

Details of track and artist(s):

DECLARATION:
I/We confirm that the production submitted is my/our own original and unaided work and that I am/we are aware of
copyright restrictions.
Name:

Signature:

Name:

Signature:

Name:
Name:
Teachers name:

Signature:
Signature:
Signature:

Return your completed application form and a DVD copy (playable on a standard DVD player preferred format .MOV)
of the moving image production to: Moving Image Awards, WJEC, 245 Western Avenue, Cardiff, CF5 2YX.

The deadline for receipt of applications and DVDs is Tuesday 21 June 2016.

Application to be made by Tuesday 21 June 2016. For a group entry, submit only one application form.
PLEASE COMPLETE FORM IN BLOCK CAPITALS
SCHOOL/COLLEGE DETAILS:
Centre number:

Centre name:

Teacher email:

Tel No.:

Teacher name:

ENTRANT(S) DETAILS:
Is this an individual or group entry? INDIVIDUAL/GROUP (delete as necessary)
Name of entrant(s)

Email address

D.O.B.

16 or under (tick)
(on 31 August 2016)

1.

2.
3.

4.

DETAILS OF PRODUCTION:
Categories: Film Extract/Short Film/Music Video/TV Sequence (Please Note: Film Trailers/Adverts are not accepted)
Category: (one of the above)
Length of Production:
Title of Production:

Brief Description of Production:

(75 words)

Date completed:

Group Member:

Group members role:

2.

2.

1.

1.

3.

3.

4.

4.

FOR MUSIC VIDEO ENTRY ONLY:

Details of track and artist(s):

DECLARATION:
I/We confirm that the production submitted is my/our own original and unaided work and that I am/we are aware of
copyright restrictions.
Name:

Signature:

Name:

Signature:

Name:
Name:
Teachers name:

Signature:
Signature:
Signature:

Return your completed application form and a DVD copy (playable on a standard DVD player preferred format
.MOV) of the moving image production to: Moving Image Awards, WJEC, 245 Western Avenue, Cardiff, CF5 2YX.
The deadline for receipt of applications and DVDs is Tuesday 21 June 2016.