OFFICIAL ENTRY FORM 10

2008 MATT’S DREAM FOUNDATION

ESSAY AND POSTER CONTEST

Place this form on back of entry for impartial judging.

Brand names on any entry disqualify entry.

CATEGORY: Poster, Essay, Poem, Photo, PSA

(Circle One)

Grade in School: ________________

Name: _________________________________ Email Address: ___________________

Mailing Address: _________________________________________________________

City: _____________________________ State: _________ Zip Code: ______________

Telephone Number: ( ) _________________________

School Name: ____________________________________________________________

School Address: __________________________________________________________

City: ____________________________ State: _________ Zip Code: _______________

School Telephone Number: ( ) _________________________

Teacher’s Full Name: ______________________________________________________

Teacher’s E-Mail Address: _________________________________________________

For Photos or PSA’s ONLY:

I authorize the MATT’S DREAM FOUNDATION to use this photo or PSA to educate the public about the dangers of Drinking and Driving. It can be used for an unspecified amount of time. MATT’S DREAM FOUNDATION will not receive financial benefit from its use.

Signature: _____________________________________ Date: __________________

Parent/Guardian Signature: ___________________________ Date: ______________

Copy Right 2006 © Matt’s Dream Foundation