Masquerade Entry Form

Please fill out all sections applicable to your costume. Write neatly, remember the Judges/MC/Tech crew/etc. all have to read it.

Entry no.
Junior Costumers [under 13]
[ ]Self-made
[ ]Adult made
Adults
[ ]Novice [ ]Master
[ ]Journeyman [ ]Not in Competition
All entries
[ ]Original
[ ]Recreation

Title of costume___________________________________________________
________________________________________________________________
________________________________________________________________

Presenters/models:_______________________________________________
________________________________________________________________
________________________________________________________________

Designers/creators: _______________________________________________
________________________________________________________________
________________________________________________________________

Source of costume:________________________________________________
________________________________________________________________

Costume type
[ ]Science fiction
[ ]Fantasy
[ ]Horror
[ ]Humor
[ ]Japanimation
[ ]Comics
[ ]Other:
     _____________
     _____________
Dominant Color
___________________
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MC/introduction-attach separate page
Mark all that apply:[ ]Tape[ ]Written Intro[ ]Other___________________

Release
I/we have read the rules of this masquerade as set forth in the instructions and I/we agree to abide by them. Further, I/we hereby grant the Millennium Philcon the right to take, publish, sell and otherwise use photographs, audio and/or video recordings taken of me as an entrant in the masquerade. I/we agree to permit the use, dissemination and publication of said images in print or electronic form in videotapes, computer images, publications, internet web pages and other media by the Millennium Philcon committee. Further, I/we agree to hold the convention, its organizers and the facility both severally and individually blameless for any accident and or injury suffered by me/us during the course of this masquerade except in the case of gross negligence on the part of those cited above.

Signed: _____________________________________________________________________________
[full legal signature required. If group all must sign. If minor parent or guardian must sign]

_______________________________________________________________________________________

Address: _______________________________________________________________________________

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Primary contact (if group) _______________________________________________________________