*Your Name:

*Your Email:

*Your Phone Number:

*Your Parent/Guardian Name:

*Parent/Guardian Email:

*Parent/Guardian Phone Number:

Please note that you will not be officially entered to win until we have written and received a response from your parent or guardian that they approve of your entry.

*Your Mailing Address:

*City:

*State:

*Zip/Postal Code:

*Country:

*Name of the File:
(Example: SmithB05011)

*Name of Picture:
(Example: Mirror in El Paso)

*Describe How Your Photograph is a Mirror or Window:
(In 100 Words or Less)

*Your Age:

*Tell us how your name & location should appear publicly in association with your photograph:
[Example: B. Smith, El Paso or Betsy Smith, El Paso, TX]

Agreement: I agree to allow Bettina Restrepo to post my photo on her Flickr account, website, blog, and Facebook page credited to my chosen name and location for an indefinite period of time without recourse. At any point I want my photograph removed from those locations, I will contact Bettina Restrepo and she will remove it upon my request.

*I certify that I have received permission to use the likeness of anyone whose face appears in my photograph and that the work submitted is mine.

*Attach your image file:

Image files must be .jpeg format,
72 dpi, no larger than 2 MB.