Contest Entry Form and Release Agreement

District: ________________________

School: ________________________

School Address: _____________________________________________________
______________________________________________________

Principal’s Name: _______________________________________

Email Address: _________________________________________

Phone Number: _________________________________________

PSA Title: _____________________________________________

With this release, I grant The Just Read, Florida! Office and The Florida Department of Education permission to use my image, voice, and content of my presentation in video productions, print, internet and/or web-based publications for non-profit, educational purposes.

Print Name:	_______________________________________

Signature:	_______________________________________

Date:		_______________________________________

•	Submissions must be in DVD format and mailed along with the completed contest entry and release form to the Just Read, Florida! Office at 325 W. Gaines Street, Suite 1548, Tallahassee, FL  32399 and postmarked by November 18, 2011

Rights Information
Florida Department of Education (requires the following rights within the State of Florida):
-	Duplication of master media to DVD by Just Read, Florida! for use as a duplication master
-	Duplication to videotape or DVD by Just Read, Florida !and Florida school districts broadcast by Just Read, Florida! on the Department of Education website, YouTube, Facebook, I-tunes, and/or broadcast and cable television.
-	Broadcast by Florida school districts on ITFS, cable access channel, television stations owned by the school district and/or Florida Public Television
-	Storage of digital files on local network for on-demand access in Florida classrooms