TITLE OF BOOK/SCREENPLAY:

GENRE OF BOOK/SCREENPLAY:

AGENT:

Contact Name:

Address:

City:

State:

Zip:

Country:

Phone:

Fax:

Email:

VALUE IN US $:

DATE SHIPPED:

SHIPPED VIA:

WAS THIS WORK SUBMITTED TO ANY OTHER FILM FESTIVALS?
YES	NO
WAS THIS WORK SELECTED FOR SCREENING? YES     NO
IF SO PLEASE LIST:
DID THIS WORK WIN A PRIZE? YES     NO
IF SO PLEASE LIST:

MEMBERSHIP:
NIIFF Member	Non-Member	Please Send Me Membership Information

PAYMENT:

Check / Money Orders must be drawn on a US Bank in US Funds, made Payable to NIIFF

I,________________________________________, am concurrently submitting a screenplay manuscript presently titled______________________________________________________.

1) No material will be accepted or reviewed without a signed release form.
2) Material will not be returned and will be reviewed and used for the sole purpose of this festival.
3) This release will not limit my copyright to the material.
4) I will no t sue the festival, its principals, nor any one associated directly or indirectly with the festival.
5) The festival or its principals have no obligations to me, including obligations to compensate or pay me unless it is stipulated in writing.

NAME:

DATE: