Adobe FormsCentral

Photographer First Name:*
Photographer Last Name:*
Phone:*
Email:*
Street Address:*
City:*
State:*
Zip:*
TO BE FILLED OUT BY ENTRANT Use this section to tell us more about the photograph entry - describe it by giving it a title. This could be one word or a phrase. Select a category and indicate which of Farm Credit Illinois" 60-counties the photograph was taken. If it was outside our 60-county territory, select "other". Finally, let us know your relationship with Farm Credit Illinois. Are you a customer, an employee or a relative of someone in those categories.
Photo Title (ex: Planting with grampa, summer fun by the pond, 4-H Proud):*
Category*
Nature & LandscapesLife on the FarmCountry LivingYouth in AgricultureOther
Select which county photo was taken*
Select what best describes the photographer"s relationship with Farm Credit Illinois?*
Attach Photo Entry (ONLY one photograph per entry form. You may submit up to 10 entries, but each photo must have a separate entry form filled out. Each photo entered must be high resolution of at least 1 MB. File formats accepted are: jpg, jpeg, png, tiff, or pdf).*
Select File
Cancelof
SUBMISSION DEADLINE: August 28, 2015

FACEBOOK "LIKES" COLLECTED UNTIL:September 4, 2015
I/we own the image submitted and hereby authorize Farm Credit Illinois to use the photo and/or reproduction of the photo including the individuals in the photo and/or the property in the photo. This includes the following media [and others not specifically mentioned] for the purpose of advertising and publicity of our services: brochures, flyers, and other collateral materials, newspaper and/or magazine advertising, direct mail campaign, annual report, and electronic media.*
By checking this box, you agree to the statement above.
Should be Empty: