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FLEXO Magazine : September 2011
All entry forms are available as interactive, fillable PDFs. Visit www.flexography.org 2012 ENTRY LOG FORM (an Entry Log Form must be completed for each entry) Entry Name: ___________________________________________________________________________ Company Name: _______________________________________________________________________ CLASSIFICATION (check one) o Wide Web o Mid Web o Narrow Web o Paperboard o Napkins o Combined Corrugated o Preprinted Linerboard o Envelope o Publications/Newspaper o Self-promotion o Student CATEGORY (check one) o Line o Screen o Process SUBSTRATE (check one) o Film o Metallized o Coated Paper o Uncoated Paper o Towel/Tissue 2012 Entry Form (complete only one Entry Form) Entry Information: Contact Name: _______________________________ Title:____________________________________________________ Company: ___________________________________ Division:_________________________________________________ Address: _______________________________________________________________________________________________ City: ________________________________________ State/Province: ___________________________________________ Zip: ________________________________________ Country:_________________________________________________ Tel: ________________________________________ Fax: ____________________________________________________ Email: _________________________________________________________________________________________________ Entry Fees: (per entry) Total number of entries enclosed: _______________________________________________________ 1-5 entries o $80.00 each (FTA Member) o $160.00 each (Non-member) Each additional entry o $70.00 each (FTA Member) o $140.00 each (Non-member) 2 FOR 1 SPECIAL OFFER! Is this your 1st time entering the competition or have not entered in more than 3 years? o $80.00 for 2 entries (FTA Member) o $160.00 for 2 entries (Non-member) Payment Method: (select one) o Enclosed is a check for $____________________, made payable to FTA, drawn on US funds. o Charge the following credit card in the amount of $_____________________ o Visa o MasterCard o American Express Number:___________________________________ Exp. date:___________________ CVC*: _________________________ Cardholder Name:_____________________________________ Cardholder Signature:_______________________________ * Enter the 3-digit code from the back of your Visa or MasterCard. Enter the 4-digit code on the front of your American Express o Paying by wire transfer (please add $20.00 for all wire transfers) Contact FTA's Customer Service Dept. at 631-737-6020 for bank information Send all entries to: Flexographic Technical Association Please mark all packages: PRINTED SAMPLES - Attn: Shelley Rubin NO COMMERCIAL VALUE 3920 Veterans Memorial Highway, Suite 9 Bohemia, NY 11716 USA PLEASE NOTE: If you would like your contract proof(s) returned, please provide the following information: Account Number:________________________________________________________________________________________ Carrier: o FedEx o DHL o UPS o TNT o Other: ________________________________________________ If an account number is not provided, contract proof(s) will be discarded immediately following the award judging. For internal use only