STEPHEN HARVARD PRIZE COMPETITION 2005 OFFICIAL ENTRY FORM

Please return one copy of this form with each sumitted work for judging. Form may be photocopied. Entries must be received by 5 p.m., Friday, 30 September 2005, to the office of Cally Gurley, Curator, MWWC, Abplanalp Library, UNE-Westbrook. 716 Stevens Avenue, Portland, Maine 04103. Competitors may enter no more than three works; each must be accompanied by a completed ENTRY FORM.

Title of work:

Submitted by(Individual(s) or Entity):

Address:

Telephone: E-mail(if avail.):

Categories in which this work is to judged--circle one or more:

Please answer the following questions:

A. Do you wish to have this work returned to you upon completion of the competition (allowing additional time for exhibit of winning entries)? Y/N

B. If you want the work returned, please give us the address to use if other than above:

C.If you do not want the work to be returned, may we donate it to a suitable institution or to one of your choice? Y/N

D. Are there any other considerations regarding this work which you wish to bring to the attention of the judges? If so, specify here:

Please sign and date each ENTRY FORM submitted, here:

(Signed)___________________________(Print Name)___________________________:

Date_______________

Any inquiries regarding the competition may be directed to Rebecca Goodale at 207-874-2240 or email: cong547A44@juno.com; Cally Gurley at 207-797-7688 or email: cgurley@une.edu; or Eliot Stanley at 207-773-2597 or email: jaes15@ maine.rr.com. Winners will be invited to attend the Meeting of the Baxter Society on November 9. 2005 to receive their awards(see Competition announcement above).

Use additional sheet if needed.