COMPETITION ENTRY FORM

for
PENANG OPEN e-CREATIVE CHALLENGE 2010 (POeCC10)
With the Theme : GO GREEN
(URL: poecc.pdc.gov.my)

Notes :
a. Before filling up this Competition Entry Form, please take some time to read and familiarize
yourself with the Rules and Regulations of the competition.

b. The participant will ensure that :

(i) BLOCK Letters are being used. Do not use abbreviations.
(ii) Make sure all information are completed and double checked for errors.
Incomplete entries will not be considered.
(iii) Use a separate form for each entry and also for each category. This form can be
duplicated.
(iv) Fill up the Parental Consent Form (Appendix A) if you are below 18 years old.

A. PARTICULARS OF COMPETITION

(1) I/We would like to participate in 2-D Animation or 3-D Animation competition (Please
select one by circulating either the word 2-D or 3-D )

(2) Participating Individual and Identity Card Numbers. Not more than 3 persons if you are
participating as a group.

No. Name New NRIC Number/Birth Certificate

(a)

(b)

(c)

(3) Name of the Group (if relevant) : _______________________________________________

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B. CONTACT PERSON PARTICULARS

Contact Person :

Address :

Handphone No. (Mandatory) :

House Tel. (if available) :

E-mail Address (Mandatory) :

C. CLOSING DATE

i. Submission of a scanned copy of the Competition Entry Form by 31 August 2010, 12.00
noon to poecc10@gmail.com or fax it to 04-6424746

ii. Submission of completed work by 1 November, 2010, 12.00 noon via CD/DVD to:
Senior Manager, ICT Division
Penang Development Corporation
No. 1, Pesiaran Mahsuri, 11909 Bayan Baru, Pulau Pinang

D. DECLARATION BY PARTICIPANT(S)

I/We hereby certify that the above information is true, complete and correct to the best of my
knowledge and I/We understand that any false statement(s) will result in my entry being
disqualified. I/We have also read and understood the Official Rules and Regulations of the above
Competition and have complied and/or abided with them.

Signature :

-----------------------------------
1st Participant

-----------------------------------
2nd Participant (if relevant)

-----------------------------------
3rd Participant (if relevant)

ENQUIRIES: Please contact Pn. Roseni Bte Ibrahim or Pn. Norasiah bte Omar, ICT Division, Penang Development Corporation, No.
1 Pesiaran Mahsuri, 11909 Bayan Baru, Pulau Pinang. Tel : 04-6340 306 / 6340 310 Fax : 04-6424 746
E-mail : poecc10@gmail.com
Thank you for participating in the Penang Open e-Creative Challenge 2010.

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 APPENDIX A

PARENTAL CONSENT FORM

FOR PARTICIPANTS WHO ARE BELOW 18 YEARS OLD

(a) 1st Participant

I (full name) (NRIC No. ) as father/mother/guardian

has no objection in allowing my daughter/son (full name) to
participate in the Penang Open e-Creative Challenge 2010, I have read the Rules and Regulations
for Penang Open e-Creative Challenge 2010 (POeCC10) and further understand and agree that the
organizer shall not be held liable for any and all losses, damages, rights, claims and actions of any
kind in connection with or resulting from my child's participation in the Competition or acceptance
of any prize, including without limitation to personal injury, death and property damage and claims
based on publicity rights, defamation and invasion of privacy.

Signature : ________________________ Date :

(b) 2nd Participant (if relevant)

I (full name) (NRIC No. ) as father/mother/guardian

has no objection in allowing my daughter/son (full name) to
participate in the Penang Open e-Creative Challenge 2010, I have read the Rules and Regulations
for Penang Open e-Creative Challenge 2010 (POeCC10) and further understand and agree that the
organizer shall not be held liable for any and all losses, damages, rights, claims and actions of any
kind in connection with or resulting from my child's participation in the Competition or acceptance
of any prize, including without limitation to personal injury, death and property damage and claims
based on publicity rights, defamation and invasion of privacy.

Signature : ________________________ Date :

(c) 3rd Participant (if relevant)

I (full name) (NRIC No. ) as father/mother/guardian

has no objection in allowing my daughter/son (full name) to
participate in the Penang Open e-Creative Challenge 2010, I have read the Rules and Regulations
for Penang Open e-Creative Challenge 2010 (POeCC10) and further understand and agree that the
organizer shall not be held liable for any and all losses, damages, rights, claims and actions of any
kind in connection with or resulting from my child's participation in the Competition or acceptance
of any prize, including without limitation to personal injury, death and property damage and claims
based on publicity rights, defamation and invasion of privacy.

Signature : ________________________ Date :