2014 Battle of the Belt PSA (video) Contest Entry Form

Enter Your Registration Number:  

Enter your School Name:  

 I have read and understand the PSA (video) Contest disclaimer:  

By entering, the entrant represents and warrants that the entry is his or her original work and that it does not contain previously published and/or copyrighted material and agrees to release, indemnify and hold harmless Missouri Department of Transportation, Missouri Highways and Transportation Commission, and any other organizations related to the contest from any and all claims, injuries, damages, or losses to the person or property and/or liabilities of any nature that in any way arise from participation in this contest or acceptance or use of a prize or parts thereof. All submissions, and any and all rights in submissions, become the property of Missouri Department of Transportation and Missouri Highways and Transportation Commission. No entries will be returned. The Missouri Coalition for Roadway Safety reserves the right to make creative adaptations to the winning entry in order to comply with copyright laws, trademarks and other licensing issues which may prevent the State from executing the PSA exactly as it is written. Each winner grants to the Missouri Coalition for Roadway Safety, Missouri Department of Transportation and Missouri Highways and Transportation Commission the right to use his or her name, likeness, hometown name, biographical information, and entry for purposes of advertising and promotion without further notice or compensation, except where prohibited by law.

Enter the PSA (video) Contest Entry Title:
(Example: PSA 01, or Why Wear a Safety Belt Oct. 10, 2011)

I will have more than 1 PSA (video) Contest Entry.

Upload Video:

Today's Date: 9/1/2014