Complete entry form

3 copies of all material per category entered

(Broadcast entries only) 3 x 150 word resume/statement of intent/transcription of material if not in French or English

(Individual applicants) letter of support on company letterhead with logo.

Category:

Name of individual entrant or organization:

Address:

Fax:                            Email:

Nominated by (where applicable):

Title of Work:

Please indicate the category:

AISI/OSIA        Radio       Print        TV         Others

IDRC 

IICD   Local Content Applications     Media Award on Local Content

Full name and title of person (s) or organization (s) whom the Award should be made to:

Where published or broadcast/website address:

Date of publication/broadcast (include time) / first online: .

Running time (broadcast only):

Credits: (broadcast material only):

Producer :                 

Director:

Editor:

Reporter:

Entry submitted by:

Name:

Position:

Organisation:

Contact address:

Tel:                           Fax:

Email:

Signature:              Date:.