M.

AXIS OLORIN
VIKING ART
CONTEST

REGISTRATION FORM
(Please Print)

Todays date:
ENTRY
INFORMATION
Last name: First: Middle: Mr.
Miss

Ms.
Mrs.
Is this your If not, what is
Home phone no.:
legal name? your legal name?
Yes No ( )
Street address: Email:

P.O. box: City:

INSTRUCTIONS: EmailBy entering the contest, each contestant warrants and represents
entry (color that submissions are the contestants sole and original work. In
photograph or digital
addition, they consent to the use of the contestants first and last
print) of artwork,and
name and artwork on the website, Facebook page and other
this completed entry
related promotions for M. Axis Olorin. Further, contestants, and/or
form to the following
legal representatives release, discharge, indemnify, and agree to
address, postmarkedhold harmless the M. Axis Olorin, and representatives or publishers
on or before May31,from all claims, damages, demands, obligations, or losses of any
2017: kind related to this contest. All communications regarding this
contest, including the announcement of winners, will be sent to the
artist. Please provide the most current contact information
m.axisolorin@gmail including the home address, and telephone number.
.com Rules and Regulations: M. Axis Olorin retains the right to use the
art in future in formats including website and social media, etc. Winners
may keep the art as intellectual property, however by signing
below grants M. Axis Olorin rights to the artwork until the year
2020. Should M. Axis Olorin wish to continue use of the artwork
after that time the artist and M. Axis Olorin may negotiate for
*PLEASE CHECK THE continued and exclusive usage of the work. Preliminary judging
INFORMATION YOU and recommendations of top art will be performed/provided by
HAVE ENTERED members of the Facebook page The Valkyr: Ascension. Prize for
ABOVE* the winning art work will be a paperback copy of The Valkyr:
Ascension.

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SIGNATURE
DATE