Library Category

Materials Included

Please type your answers; attach separate sheets as necessary.

1. Sent by:_________________________________
   (library, agency, organization)
   Address:_________________________________
   City:_____________________________________ 
    
   State:______  Zip:__________
   Phone: _________________ Fax:_____________
   Email:___________________________________
   Library Director:___________________________
   Signature (required):________________________
    
   Contact Person:
   Name_______________________________________
   Title________________________________________
    

2. Short, Descriptive Title of Entry Submitted:
    
   ____________________________________________
    
   ____________________________________________
    

3. Opening and closing dates of public relations entry being submitted:
    
   ____________________________________________
    
   ____________________________________________
    

4. Budget Data (for information purposes only):
   
   Total annual library budget (including salaries):__________
   
   Cost of public relations program being submitted:
   
   - To libary:______
   - In-kind:_____
   - Total: _____
    

5. Professional Support: 
   Did you use the services of an outside professional(s) on this program (for example, an advertising or public relations firm, media production company, commercial artist)?
   Yes________ No________
    
   If Yes, identify their services and costs:
   ______________________________________________
    

6. Copyright/Trademark:
    
   Did you use copyrighted material? 
    
   Yes________ No________
    
   (If Yes, a permission release from the copyright or trademark owner must be included or entry will be eliminated.)