Photo Salon Entry Form Instructions: You may complete this form on your computer (pre-ferred), or print it and complete it by hand. Continue on the second page, if needed. The entry fee is $1.00 per film slide and $0.25 per digital image. There is a limit of 30 entries per photographer. A single payment for all entries may be made by check payable to “NSS” and included with the entries.

Photographer(s) _____________________________________________________________ Street Address ______________________________________________________________ City ______________________ State/Province ______________ Postal Code __________ Country ______________ Telephone ________________ E-Mail _____________________ Instructions: You may use a second line to describe or comment on each entry, if desired. Continue on page 2, if needed. For a story series, list all images on the same page of the form, use the same entry number for all images, and include the sequence number of the image at the beginning of the title box.

Entry# Category Title

The NSS requests the following limited rights to your entries. These rights are optional. Please

indicate your agreement with any and/or all of these rights by marking the boxes:

The NSS may publish winning images in periodicals for the purpose of showcasing contest winners, within one year of the contest. The NSS may publish winning images in periodicals for the purposes of promoting future congresses and competitions, for not more than four years. The NSS may use these images in low resolution on Web sites to announce the winners of this competition, for not more than four years. The NSS may use these images in low resolution in a CD/DVD of all entries. This CD/DVD will be lent to NSS members for viewing at no charge.

Signature ____________________________

Photo Salon Entry Form – page 2 Entry# Category Title