Complete this form to enter the Mask Up Alabama video contest. You must be an Alabama citizen, and if you're less than 18 years old, you'll need your parent/guardian's signature to enter.

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* 1. Name:

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* 2. Email address:

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* 3. Phone number:

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* 4. Hometown:

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* 5. Please enter the year you were born:

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* 6. Title of your video

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* 7. Link to video on YouTube/Vimeo

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* 8. With my electronic signature below, I verify that the video submitted is the work of my own creation and that all individuals who appear in the video have given their permission for the video to be posted on websites and social media sites.

I understand that the sponsoring organizations will be using the winning videos in numerous social media sites to help promote masking.

I affirm that I have read YouTube Terms of Service (www.youtube.com/t/terms), YouTube Community Guidelines (www.youtube.com/yt/policyandsafety/communityguidelines.html) and Vimeo Guidelines (www.vimeo.com/help/guidelines). Entries which do not comply will be disqualified.

I acknowledge that the Alabama Department of Public Health, the Alabama Hospital Association and the Medical Association of the State of Alabama are responsible for these rules and all aspects of the contest administration. I acknowledge that this contest is not endorsed, administered, or associated with Facebook, Vimeo, or YouTube. I release Facebook, Vimeo, and YouTube from any and all liability related to this contest.

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* 9. Date of signature:

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* 10. If less than 18 years of age, signature of parent:

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* 11. Date of parent's signature

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