INSTRUCTIONS: Please PRINT, then fill in all entry information requested below in legible block letters or typed letters.

The 21st Tokyo Video Festival Entry Form Attach(paste/tape) this form to the tape case			Date: Month __ Day __ Year __		(only for sponsor's use) Receipt No.
Title					Tape Playback Time	Min: Sec:
[ ]Individual	Name:	Sex: [ ] male [ ] femal	Age:	Category of entry:	[]General	[]Artistic
[ ] Group	Group Name:			Video Experience:		years:
Address	[] Residence [] Other			Phone number:
				Fax number:
				E-Mail Address:
Occupation	[]Company employee []Student []Self-employed []Free-lancer []Teacher []Civil Servant []Artist []Homemaker []No occupation []Other ( )		Is any material in this submission copyrighted? []Yes []No []Music []Other Have you obtained permission to use it? []Yes []No
Audio	[]Without Audio	DV system: []Full sound []Sound1 []Sound2	Equipment used for filming: Manufacturer & model names:
	With Audio []Hi-Fi []Stereo []Normal []Monaural
	Instructions, if any additional, for playback:
Brief Description (Explanation) of this work
The undersigned verifies that all information contained herein is correct,and that he/she or the group he/she represents is solely responsible for the contents of the submitted video and has all rights to it,and if it receives an award at the 19th Tokyo Video Festival,authorizes the sponsor to make copies of,exhibit,screen,distribute,broadcast or re-broadcast by cable or air waves for non-commercial and promotional purposes. Signature

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