Q.1
Name *



Q.2
Address *





Q.3
Phone Number *

Q.4
Alternate phone number

Q.5
Email Address *

Q.6
Have you or the organization you are associated with (if applicable) exhibited at the Jacksonville Public Library before? If so, when and where? *

Q.7
Describe the credentials and/or previous relevant accomplishments of the artist, including previous public exhibits of work (if applicable): *

Q.8
Image Release Form - All artists must fill out a form (Printed name acknowledges consent) *

By printing my name on this Image Release form, I, the artist, agree to the following:
I hereby grant to the City of Jacksonville, its respective licensees, successors and assigns (herein collectively called the “Licensed Parties”) the right to perpetually use, exploit, adapt, modify, reproduce, distribute, copyright, publicly perform and display, in any form now known or later developed, my image or visual likeness, my name and/or my artwork, throughout the world, in all media (the “Works”) for the City of Jacksonville. I understand there will be no monetary compensation for my participation in any advertising or promotion. I understand that nothing herein obligates the Licensed Parties to use my name, picture, portrait, likeness, occupation and testimonial in the manner described herein.

Q.9
Image Release Form - (continued) - Print name in box below to acknowledge consent *

I release and hereby agree to indemnify, defend, and save harmless City of Jacksonville, its agents, employees, licensees and assigns from any and all claims I, or any third party, may have now or in the future for invasion of privacy, right of publicity, copyright infringement, defamation or any other cause of action arising out of the use, exploitation, reproduction, adaptation, distribution, broadcast, performance or display of the Work.

I understand that the Work may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein the Work appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the Work or this authorization. Licensed Parties shall not be responsible for any third-party, unauthorized use of the Work.

Q.10
Parent or Guardian Signature *

By printing my name on this Parent/Guardian consent form, I, the parent or guardian of (insert name of child below), give permission for participation in the Jax Book Fest Poster Contest and agree to the rules and regulations.

Q.11
Upload your poster submission (JPG and PDF formats only) *