Photo Submission

First Name*

Last Name*

Email*

Phone Number*

Address

Address 2

City

State

Zip

Photo Upload 1*

(Do not upload files containing sensitive personal information.)

Photo Title*

Photo Upload 2

(Do not upload files containing sensitive personal information.)

Photo Title 2

Photo Upload 3

(Do not upload files containing sensitive personal information.)

Photo Title 3

Photo Upload 4

(Do not upload files containing sensitive personal information.)

Photo Title 4

Category Selections (check all that apply)*

Employers & Work

Infrastructure & Progress

Healthcare & Education

Community Life

Photo Location*

Brief Description (100–250 words recommended)*

Does this photo contain identifiable individuals?*

Yes

No

I certify that I have obtained permission from all identifiable individuals appearing in this photograph.*

If minors are depicted, I certify that parental or legal guardian consent has been obtained.*

Certification*

I certify that this photograph is my original work and that I am the owner of the image.

I have read and agree to the PCEDA Photo Contest Terms and Conditions.

Type Full Name*

Date*

Picture Preston County Photo Contest Photo Submission