The Livingston Awards for Young Journalists: Entry Form


1.Entrant(s)

NameBirthdate

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Daytime phone/fax______________________________________________________________________

Home phone______________________________________________________________________

E-mail address_________________________________________________________________________

Name/phone of contest coordinator, if applicable
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2.Entry published/aired

Organization
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Address
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City, State, Zip
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Phone/Fax
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Corporate Ownership, if any
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Check if freelance ______ and indicate address
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3.Editor/Producer for the entry (Name/Title/Phone/Fax)
_____________________________________________________________________________________
4.Medium (circle one)         Newspaper         Magazine         TV         Radio         Online
5.Category (circle one)         Local         National         International
6.Qualifying Material (limit of three pieces, if part of a series):

Title(s) Headline(s)Date(s) Published/Aired

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____________________________________________________________________________________

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7.How did you learn of the Livingston Awards competition?

      Poster       Publication Ad or Listing       Friend/Employer       Other_______________

8.Sworn Statement of Age___________. I (signature)____________________________________________ attest that as of December 31, 2008, I will be younger than 35 years of age. Permission to duplicate entry limited to Livingston Awards use.

Note: Contest finalists will be notified by May 1, 2009. At that time, they must submit a copy of their current U.S. driver's license, birth certificate, or passport identification page.

NO ENTRY FEE · DEADLINE: FEBRUARY 1, 2009