Entry Form

This form should be securely fastened on the back of each photo submitted.
Please PRINT.

Name:______________________________________________________________________

Mailing address:______________________________________________________________

City/State/Zip:________________________________________________________________

Phone: ___________________ E-Mail:____________________________________________

Group (please circle) Kids (12 and under) -- Teens (13-18) -- Adults (over 18) -- LUMCON Employee

Title of photo:

Location, time of day, and circumstances under which photo was taken:

Describe how the photo depicts the theme: