Video Contest Submission Form How to enter | Crucial dates | Prizes | Other guidelines | Submission form Be sure you have read the rules for this contest. Please fill out this form completely. You can either attach your video to this form or upload it to YouTube and include the address of it on the form below. Good Luck! Viewed by:ApprovedYesNoComment?Your Name*Videographer if different from aboveYour email address* Enter Email Confirm Email PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Entry Category*ChildrenAdultsFamilyADHD ProfessionalsActors in this video are*Only meMy family and/or meOther people, tooPlease list other actors from your family who appear in this video*You must have a signed copy of the Actor release form for each actor who is not in your family. (or actor's guardian if the actor is younger than 18) Download the Actor/Model Release form here Also please supply the information in the following form.Model Permissions GrantedThe Model(s) granted the Photographer permission to photograph and/or film and sound record the Model and furthermore grant permission to use the resulting work ("the Work") according to the terms stated hereunder: 1. Any permission granted to the Photographer shall extend to his/her successors, legal representatives, licensees and assigns and shall be irrevocable and perpetual without any further or additional claim for compensation by the Model. 2. Use of the Work shall be unrestricted as to location, quantity or frequency, may be for any purpose and in any medium whatsoever, whether foreseen or unforeseen at this time, except where such use is in contravention of the law. 3. Permission is specifically granted for the Work to be edited, altered, distorted, used in whole or in part, in conjunction with other images, graphics, text and sound in any way whatsoever and without restrictions. Full legal name of additional actors*List additional actors separated by comasTelephone numbers of actors*List additional actors separated by comasEmail addresses of actorsList additional actors separated by comasFull address of actors*Each of the following will require a check box in order to submit the form.* I certify that I have not used copyrighted, trademarked or branded material, including music or images in my video. I have not included photos, music or images that I stole or downloaded that belong to someone else. * All of the people appearing in the video know they are in the video and have read this video release agreement. If they are not included on the submission form as members of my family, I have included a separate signed release from them or their parents/guardians if they are under 18 years of age. * I acknowledge that ADHDAwarenessMonth.org and the coalition member organizations of ADHD Coaches Organization (ACO), Attention Deficit Disorder Association (ADDA) and Children and Adults with ADHD (CHADD) (“the coalition”) have my permission to use the video and my image and statements (or those of my minor child/children) during the contest period and for any organizational purpose after the contest, without notification, consent or compensation. Organizational purpose includes, but is not limited to, displaying the video on the internet, at conferences, or at other venues, regardless of whether fees are charged. * I understand that I will not be paid for the use of the video and my image and statements should the video be used for organizational purposes after the contest. I have read and understood this Agreement* and I am fully familiar with all the terms therein. Video Title*Video description*Please give us about 20 words about your video (150 characters including spaces)Video Length*Videos should not be longer than about 2 minutesVideo submission logistics*I have already added my video to YouTubeI want to attach it to this formI can't make this workURL of YouTube Video Please do not use short codes. We need the actual YouTube URLUpload your video hereBe sure to wait til it's fully uploaded before closing this windowAccepted file types: mov, mp4, wmv.If you can't get your video to upload and you can't put it on YouTube yourself, then you must contact firstname.lastname@example.org for additional help. That will require you to be able to store your video somewhere where we can get to it. For example a DropBox account or some other storage facility. NameThis field is for validation purposes and should be left unchanged.