P.O. Drawer 1030, New Iberia, Louisiana 70562-1030 USA

“ORIGINAL” Louisiana Hot Sauce Video Contest

Copyright Form

Contestant’s Name________________________________________________________

YouTube URL___________________________________________________________

I ________________________ confirm that I am the original author of all parts of the

(Entrant/Contestant)

video or have permission to use copyrighted material. I confirm that I have the consent

of all parties displayed and/or heard in video to enter this contest and that their signatures

are below.

Please provide a detailed description of all music used in your entry. (Title, artist, etc.) ________________________________________________________________________________________________________________________________________________________________________________________________________________________

_____________________________ ________________

Entrant/Contestant Signature Date

_____________________________ ________________

Additional Parties’ Signature Date

_____________________________ ________________

Additional Parties’ Signature Date

_____________________________ ________________

Additional Parties’ Signature Date

_____________________________ ________________

Additional Parties’ Signature Date

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Additional Parties’ Signature Date

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Additional Parties’ Signature Date