Entry Application

Please review our Guidelines before submitting your entry

All Entries must include:
• The entrant’s name (individual or organization)
• Complete address, phone number, email and website.
• Team Members
• Title, Description and who the target audience is (Who is the message supposed to appeal to?).
• Select category for entry.
• Narrative (submit via this form or in follow-up email)

International Safety Media Award Entry Application
Contact Information
Organization:
Name:
Street:
City:
State:
Zipcode:
Country:
Phone:
Email:
Website:

Team Members

Please list the names of your team members in the space provided below:

Entry Information
Title:
Description:
Target Audience:
Category : (please check the category for your entry)

Print / Adult	Audio / Adult
Print / Youth	Audio / Youth

Film / Adult / Ultra Short	Film / Adult / Short	Film / Adult / Feature Length
Film / Youth / Ultra Short	Film / Youth / Short	Film / Youth / Feature Length

Evaluation Narrative

If the media submitted for this ISMA Contest was used in a media campaign and the campaign was evaluated, then describe in writing (1500 words or less) the methodology and effectiveness of the campaign. This description can be submitted below, or by attaching it to the entry:

1. Once you have submitted the entry form, you will receive an email copy of the form with further instructions. Please review it for accuracy. 2. Once you have reviewed the form contents, you will be directed to click the reply button in your email program and attach your evaluation narrative (if not submitted above) and your entry attachment.