2006 Short Story Entry Form

Deadline: July 1, 2006 Child's Name ________________________________________________ Age as of 7/01/06 ____ Mailing address __________________________________________________________________ City/State/Zip ___________________________________________________________________ Grade in school __________________________________________________________________ School Attending _________________________________________________________________   Title of Story ___________________________________________________________________ Number of Words _______________________ (Refer to contest rules for story length) (The word count includes "a," "an," & "the.") By entering the 2005 Book 'Em Foundation's (BEF) Short Story Contest, I give permission for the BEF to use this work, which will be credited to the entrant/author, as it wishes, including, but not limited to, display, promotion, reproduction and distribution in all media and the right to create, perform, display and distribute derivative works. I also give them the right to use the entrant/author's name, likeness and biographical material in connection with the work. I understand the stories may not be returned. I release the BEF, Waynesboro Police Department, sponsors and the officers, directors, employees, licensees and successors from any liability in connection with this Contest submission. I acknowledge that I have read this consent and release prior to signing it and that I understand its contents. I warrant that this child alone has created the story text for this Contest.   Parent/Guardian Signature __________________________________________________________ email address____________________________________________________________________ Printed name __________________________________________ Date _____________________ Mailing address__________________________________________________________________ City/State/Zip _____________________________________ Phone (____) __________________

Please send entries to:
BEF Short Story Contest
C/O Waynesboro Police Department
Attn: Officer Kearney
250 S. Wayne Ave.
Waynesboro, VA 22980