2005 Wild Ones Photo 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 ___________________________________________________________

Wild Ones chapter affiliation ____________________________________________
(If not a member of a chapter, indicate PAL for partner-at large.)

Photo category ________________________________________________________

I am entering as an adult __________ in the Kid's Photo category ________________

Title of photo _______________________________________________________

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


Optional:
Type of camera ____________________________________________________

Type of film (if any) _________________________________________________