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Fill and Sign the Wsib Optional Insurance Request Change Form

Fill and Sign the Wsib Optional Insurance Request Change Form

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THE 19th ANNUAL CHICAGO UNDERGROUND FILM FESTIVAL ENTRY FORM – Please read all entry guidelines before completing this form. Thanks. Mail to: Chicago Underground Film Festival c/o IFP Chicago PO Box 3065 Chicago, IL 60654 EARLY DEADLINE Nov 21 DEADLINE Jan 15 LATE DEADLINE March 1 *** PLEASE PRINT CLEARLY *** Picture Title____________________________________________________________________________ Running Time____________________ Date Completed (month/year)______________________________ Director(s)_____________________________________________________________________________ Company______________________________________________________________________________ Address_______________________________________________________________________________ City/State/Zip___________________________________________________________________________ Country________________________________________________________________________________ Telephone________________________________ Email________________________________________ Website__________________________________ DEADLINES Early Deadline: November 21, 2011 - Entry Fee: Features $35 (Students $20); Shorts $30 (Students $15) Regular Deadline: January 15, 2012 - Entry Fee: Features $45 (Students $20); Shorts $35 (Student $15) Late Deadline: March 1, 2012 - Entry Fee: Features $55 (Students $25); Shorts $40 (Student $20) Make check or money in US Funds payable to: IFP/Chicago NOT Chicago Underground Film Festival Foreign submissions must pay fees by credit card or International Money Order drawn from US banks. Entry Fees are not required from filmmakers who have screened at CUFF in the past. Please indicate the name of your film and the year it was screened below. Film Title: ____________________________________________________ Does Your Entry have US Distribution? ❏ yes ❏ No Year Screened________________________ if yes with what company? ________________________ Preview Tape Format ❏ NTSC VHS ❏ PAL/SEACAM VHS ❏ DVD Final Screening Format ❏ 35mm ❏ 16mm ❏ Video (format) _________ Category (circle one only) ❏ Narrative Feature ❏ Documentary Feature ❏ Experimental ❏ Animation ❏ Narrative Short ❏ Documentary Short ❏ Music Video Original Production Format(s) ❏ 35mm ❏Super 8 ❏16mm ❏Video (format) _________ Will this screening be a premiere? (Premiere status is based on previous theatrical or festival screenings) ❏ WORLD PREMIERE ❏ US PREMIERE ❏ MIDWEST PREMIERE ❏ CHICAGO PREMIERE Please include a brief written description/synopsis and/or artist’s statement of the film. Additional press materials will be requested upon acceptance Other public screenings, festivals and awards___________________________________________________________________ Signature _______________________________________________________________________________________________

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