Creative License ENTRY/RELEASE FORM/2012 EditionPRIVATE

 

Name:_____________________________________________________________


Address:______________________________________________________________________________

 

______________________________________________________________________________________

 

Phone:_____________________________________________

 

Student ID#:  900________________________________


Student’s GPC e-mail address: _________________________________________

 

Work(s) under consideration for 2012 Creative License [exact titles--no untitled works]:

(Students may submit up to four entries per each category: poetry (including song lyrics), short story, art, and photography.)

 

a.       ________________________________________________________

 

b.      ________________________________________________________

 

c.     ________________________________________________________

 

d.      ________________________________________________________

 

 

Your name exactly as it should appear in Creative License:

           

_____________________________________________________

 

RELEASE:

 

            Creative License has my permission to publish the above listed work(s) under consideration.  I understand that the copyright(s) reverts to me after publication of the 2012 issue of Creative License.  By signing below, I also verify that the work is my original work, has never been published before, and is not currently being considered for publication elsewhere.  I also verify that I was a Georgia Perimeter College student in good standing at the time I submitted the work(s) for consideration.

 

                                                Signed:___________________________________

  

                                                Date:  ___________________________________

 

Note:  One copy of this form must be submitted with all entries, along with a non-returnable CD or flash drive (containing the work(s) being submitted), and a printout of the literary entries.  (A digital file is needed for artwork and photography—high resolution images only.)  Submit all entries to your Student Life Office or campus Creative License advisor, Deborah Byrd, Humanities Department (Newton Campus) by 4:00 p.m., Wednesday, December 14, 2011.    If you have questions, please e-mail me at Deborah.Byrd@gpc.edu