Photo Contest Entry Form

Question Title

* 1. Before you fill out this entry form, please check below to indicate that you understand and agree with the following:

I understand and agree that any information I fill in on this entry form and the following pages is sent to a company outside DSHS called Survey Monkey to collect and send to DSHS. That company does not collect personal information about me other than what I enter on this form and does not use that information for its own purposes. Click here for their privacy policy.

Please fill this form out once for EACH picture submitted. (Be sure to press "Next" at the bottom as the form has more than one page.)

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* 2. Photographer Information:

Name

Phone Number (include area code)

Email address

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* 3. I am a...

DSHS Employee

Former DSHS Employee

Family Member of a DSHS Employee (current or former)

DSHS Client

Family Member of a DSHS Client

I prefer not to share this information.

Other (please explain)