THE NATIONAL ACADEMY
OF TELEVISION ARTS & SCIENCES
MIDSOUTH REGIONAL EMMY® AWARDS FOR ACADEMY USE
OFFICIAL ENTRY FORM ENTRY # ___________
EACH ENTRY MUST INCLUDE:
1. TWO copies of Broadcast/Cable/Internet
entry on DVD-R
2. TWO completed copies of the official
entry form (or photocopies) for EACH entry, including 100 word synopsis
(optional, except where noted). No attachments to entries, except Set Design.
3. You must edit out commercial content
leaving two to five seconds of black.
4. Payment form or payment receipt
5. Send entries to: EMMY AWARDS, 161
Rains Avenue, Nashville, TN 37203, by August 20, 2010
CATEGORY NUMBER ___________ CATEGORY NAME
________________________________
ENTRY TITLE ____________________________________________
RUNNING TIME _________
PRODUCING COMPANY
___________________________________________________________
ORIGINAL AIRDATE ______________________ STATION AIRED
________________________
MEMBER ENTRIES $75 PER PERSON;
NONMEMBER ENTRIES $175 PER PERSON
PERSON(S) TO RECEIVE AWARD:
1st ENTRANT _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _
MEMBER __ NONMEMBER __ FEE $ ________ CONTRIBUTION TO THIS
PROJECT _ _ _ _ _ _ _ _ _ _
2nd ENTRANT _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
MEMBER __ NONMEMBER __ FEE $ ________ CONTRIBUTION TO THIS
PROJECT _ _ _ _ _ _ _ _ _ _
3rd ENTRANT _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
MEMBER __ NONMEMBER __ FEE $ ________ CONTRIBUTION TO THIS
PROJECT _ _ _ _ _ _ _ _ _ _
4th ENTRANT _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
MEMBER __ NONMEMBER __ FEE $ ________ CONTRIBUTION TO THIS
PROJECT _ _ _ _ _ _ _ _ _ _
5th ENTRANT _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
MEMBER __ NONMEMBER __ FEE $ ________ CONTRIBUTION TO THIS
PROJECT _ _ _ _ _ _ _ _ _ _
6th ENTRANT _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
MEMBER __ NONMEMBER __ FEE $ ________ CONTRIBUTION TO THIS
PROJECT _ _ _ _ _ _ _ _ _ _
When a SINGLE payment covers MULTIPLE ENTRIES, a list of
each category, name of entrant and individual entry fee MUST accompany the
check. MEMBERSHIP FEES MUST be submitted on a SEPARATE CHECK, including a list
of new members.
PERSON SUBMITTING
ENTRY ______________________________________________________
COMPANY_________________________________________________________________________
STREET
___________________________________________________________________________
CITY
______________________________________________ STATE _________ ZIP _____________
TELEPHONE
(required) ____________________ E-MAIL (required)____________________________
SIGNATURE
_________________________________________________________________________
Signature
constitutes permission to telecast, webcast, videostream or screen all or
portions of the entry as part of the Emmy® Awards Program and promotion.
SYNOPSIS: Optional, unless otherwise noted. One page limit of objectives, or any
information you deem advantageous for the Judging Committee. Please use reverse side.
|
PAYMENT FORM – EMMY® AWARD ENTRIES
.
Membership fees
should be paid separately, and should not be included in your calculations of
total entry fees owed
$_________Check
Amount Payable to NATAS Nashville
$_________Purchase Order Amount to NATAS Nashville, 161 Rains Avenue, Nashville, TN 37203 $_________Charge Amount to American
Express
$_________Charge
Amount to MasterCard or Visa.
Credit Card - - -
Security Code
________________
(4 digits on
front of American Express, or 3 digits on back of MasterCard or Visa)
Name of
Cardholder____________________________________________________________
Expiration Date
________________________________________________________________
Billing
Address________________________________________________________________
City, State,
Zip________________________________________________________________
The Academy falls
under IRS Code 501 (c)(6), and the Chapter Federal ID is 94-293-8871
|