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MINISTRY OF CULTURE, YOUTH AND SPORT

Walter Roth Museum of Anthropology National Logo Competition REGISTRATION FORM 2013
NAME: ADDRESS: DATE OF BIRTH: E-MAIL: TELEPHONE:

DETAILS AND DESCRIPTION (SIGNIFICANCE) OF SYMBOLS OR PICTURES USED ON YOUR LOGO:

AUTHORISATION: a. I hereby submit my work to the Walter Roth Museum of Anthropology as a potential Logo for the institution. b. I authorize the Walter Roth Museum of Anthropology to photograph, modify, reproduce and use the artwork I have submitted, for purposes of documenting Marketing and promotion the institution. c. I Acknowledge that upon submission of my artwork to, the Ministry of Culture Youth and Sport and the Walter Roth Museum of Anthropology permission is granted to include my artwork in all subsequent editions of the museums publications signage and books, in all media of expression now known or later developed and in all foreign language translations and other derivative works published or prepared by the Walter Roth Museum of Anthropology, for distribution throughout the world. Signature: Date: DECLARATION: a. I declare that the artwork I have submitted is my original creation. b. I accept and agree to abide by the rules of the Walter Roth Museum of Anthropology National Logo competition. Signature: Date:

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